Patient at Newham Acute Day Hospital launches campaign to fight closure

By our reporters

Thirty one year old James Blampied is currently a patient in the Newham Acute Day Hospital in east London. He wrote to NHS Fightback and the Socialist Equality Party on the plans of the East London NHS Foundation Trust’s (ELFT) to shut down its day hospital where he receives care, in April. The hospital was opened in 2000 and has been the lifeline for thousands of people who suffer from mental health problems and those that would otherwise be treated at inpatient hospital

james-blampiedJames Blampied

ELFT, which received a rating of “outstanding” as a mental health trust last year by the Care Quality Commission (CQC) has slated Newham Acute Day Hospital for closure, along with streamlining the Community Learning Disability Services. ELFT was appointed as the provider for the new contract of Community Learning Disability Services by the Tower Hamlets Clinical Commissioning Group.

ELFT admits that the Newham Acute Day Hospital “has provided a good service to patients over the years” but says that it is “important that mental health services modernise and adapt to respond to current circumstances and the needs of patients.” The reality is that ELFT is trying to “adapt to respond to current circumstances”, i.e. cut spending, rather than meet patients needs. The Trust plans to save money from the closure while giving lip service to investing some of the money saved to improve the Home Treatment Team in order to “reduce the impact of Day Hospital’s closure.”

Between 2010 and 2014, ELFT imposed £41 million in “efficiency savings”, as part of the Conservative/Liberal Democrats coalition demands to cut £20 billion from the National Health Service. In its Strategic Plan for March 2015-2019, the ELFT foresees a financial gap of £56 million in a “do nothing” scenario by the end of that period. This is happening due to the lowest ever funding increase for NHS in its nearly 70 year history under this government and its predecessor.

The Tories are demanding the NHS is cut by a further £22 billion in this parliament via efficiency savings. To achieve this, they have formed 44 Sustainability and Transformation Plans (STPs) across England, accelerating the process of downgrading and closure of Accident and Emergency (A&E) departments, maternity units, children units, mental health facilities and walk in centres across country.

The North East London (NEL) Sustainability and Transformation Plan, which includes ELFT, identifies the area as one of 11 “challenged health economies.” The STP is predicting a financial gap of £578 million by 2021 and says that, “cost improvement programmes will no longer be enough to achieve the scale of efficiency required to address our system-wide financial challenge.”

It states, “The STP has given providers the impetus to co-design new opportunities for productivity and service efficiency improvements beyond traditional organisational boundaries.” The closure of Newham Acute Day Hospital on which many vulnerable patients with mental health needs depend, is part of the “co-design.”

the-newham-acute-day-hospital

 Newham Acute Day Hospital

Cuts to mental health services have led to a situation where there is enormous demand, with little capacity to meet the need. In the five years up to 2016, mental health trusts in England had £600 million slashed from their budgets. Meanwhile the number of people seeking mental health community help has jumped by almost 500,000 a year, to 1.7 million, since 2010.

ELFT has set up dates for obligatory but bogus public consultation this month in order to appease the public. James with the help of other patients has launched a parliamentary petition to avoid the closure. The petition states, “Newham Acute Day Hospital has helped 1000s of people with mental health problems who are in crisis. The hospital is a vital, life-saving alternative to inpatient admission. Let’s take a stand against NHS cuts at a time when mental health problems are at epidemic levels in the United Kingdom.”

James recently spoke to us at the hospital site.

He said, “I am 31 year old and I have been suffering from depression since 2005 and have more recently been diagnosed with Bipolar Disorder. I have attended the Newham Acute Day Hospital twice in 2015 and I am currently a patient there. Newham mental health centre has been the real turning point in my recovery.

NHS FightBack:
How many patients and families benefit from the Newham Acute Day Hospital?

JB:
There are approximately 20-25 patients admitted to the Newham Acute Day Hospital for an average period of 4-6 weeks per patient, and approximately 300,000 people have access to the hospital complex.

NHS FightBack:
What would happen to you and other patients as a result of the day hospital closure?

JB:
The current treatment at the day hospital includes group therapy, consultations, and the support from fellow patients is a large part of the treatment. There is a large community spirit fostered by the communal activities. As a result of the closure, the home treatments would not include any of this group treatment but would rather consist of 10 minute per day home visits.

The day hospital is also an alternative to being admitted to the Mental Health Inpatient Ward, allowing those requiring treatment to attend during the day but remain living at home, which is considerably preferable for mental health. Without the day hospital, many patients will have no other option but to be admitted to the general hospital ward, which is a less favourable environment for the recovery of patients with mental health issues.

Ambulance and police services and Accident and Emergency departments are inadequately prepared for mental health issues and are already oversubscribed. General recognition is that many people suffering with mental health issues would be worse off through these more general outlets of treatment.

NHS FightBack:
The East London NHS Foundation Trust says they are going to incorporate the services provided by the day hospital with Newham Home Treatment team as an alternative. Would the home treatment service provide you the same level of service at home?

JB::
The home treatment team would not provide same level of treatment. Not only are the planned treatments vastly reduced in time per day than the time patients spend at the day hospital, but the treatment that the home treatment team are able to provide is on an individualistic basis and the patients would not have the same access to consultants and benefits resulting from group therapy.

NHS FightBack:
Are you aware that the ELFT is going to streamline the Community Leaning Disability Service in addition to the closure of the day hospital?

JB:
I am not aware of these intentions to streamline the Community Learning Disability Service.

NHS FightBack:
Why do you think they are doing this?

JB:
Patients are being told that the hospital is being “underused” which I think may be a result of the referral problems. But many people with mental health problems benefit from the day hospital.

NHS FightBack:
Do you think this is part of the wider attacks on the NHS?

JB:
I recognise the closure of the day centre is part of the wider attack on mental health–other patients also recognise that mental health and those most vulnerable seem to be the hardest hit. Hackney mental health centre has already or is planned for closing, and possibly Barking mental health centre.

NHS FightBack:
Have you contacted any organisations other than the Socialist Equality Party/NHS FightBack? What are their responses?

JB:
I have contacted Save our NHS, local and national mental health charities (e.g. Mind), local press—an article is forthcoming. I have written to the local Labour MP, Stephen Timms, but not received any reply as of yet.”

NHS Fightback also spoke to a member of staff at Newham Acute Day Hospital Closure, who said, “Patients and we are gutted by this decision to shut down this well-functioning unit. We haven’t been given an acceptable reason as to why this is going to be shut down in April. The decision is coming from the management of the Trust.”

Asked about the number of referrals to the hospital, he said, “Patients may be referred to the day hospital through the Community Mental Health Team, the Assessment and Brief Intervention Team (ABT), and the GPs or the hospital crisis team. We have got a capacity for 25 patients and we have got 18-20 patients a day. So we are not underused.”

NHS FightBack calls for the widest possible campaign among health workers in London and the public to fight the closure of Newham Acute Day Hospital.

The petition created by James Blampied is here

Spending cuts deepen crisis in NHS mental health services

By Jean Gibney

The National Health Service (NHS) in the UK is, according to the Red Cross, facing a “humanitarian crisis.” Its assessment followed the recent deaths of two patients who died while waiting on trolleys in hospital corridors for treatment. These tragic deaths underline the deliberate, ongoing destruction of the NHS.

This process is part of the privatisation and slashing of funding for all public services. Every aspect of public health care is currently under attack.

A recent report by the Nuffield Trust—a health policy research body—on the increasing rise in waiting times for all treatments revealed dangerous levels of delay in those waiting for diagnostic tests. The trust revealed that waiting times for diagnosis and diagnostic testing doubled from 2008 to 2016. In December 2008, 403,955 people were waiting for diagnostic tests. In January 2016, this had increased to 818,599, and rose further to 882, 321 in September 2016.

Cuts to mental health services have led to a situation where there is enormous demand, with little capacity to meet the need. In the five years up to 2016, mental health trusts in England had £600 million (US$751 million) slashed from their budgets. Meanwhile the number of people seeking mental health community help has jumped by almost 500,000 a year, to 1.7 million, since 2010.

The 1997-2010 Labour government was instrumental in cutting the number of overnight beds available for those requiring mental health support. The number of beds available fell from 34,124 in 2001 to 19,249 in 2015.

Figures made available last year by the King’s Fund think tank estimated that 40 percent of 58 mental health trusts in England s aw their budgets cut in 2015-2016. Six of the trusts saw their budgets slashed three years in a row.

Government data obtained last September showed that 73 local areas will see their General Practitioner mental health budgets slashed in 2016-2017. In Haringey, one of the poorest boroughs in London, the Clinical Commissioning Group is to cut 16 percent of its mental health budget.

Recent figures for mental health waiting lists in the Greater Manchester Area in North West England reveal a huge crisis in patients unable to access mental health services. Over 200 patients waited for treatment for 90 days, double the regional wait of 27 days and almost five times the already high national average wait of 18.8 days.

Patients who find themselves in crisis due to the unavailability of doctors’ appointments, hospital referrals and lack of community social care services are forced to attend accident and emergency (A&E) departments.

The BBC noted in January that data compiled by NHS Digital “showed that between 2011-12 and 2015-16 the number of patients attending A&E units with psychiatric problems rose by nearly 50% to 165,000.”

These do not include those patients who may have been recorded as attending for other reasons.

The BBC reported that some trusts it had spoken to “said as many as a tenth of patients were attending A&E because of mental health problems.”

The Crisis Care Concordat—set up by the Department of Health with a remit to improve outcomes for patients with mental health issues—was already warning in 2015 of an NHS “system failure.” This had led to large numbers of people in mental distress turning to A&E for help, due to inadequate community-based mental health services, it said.

The warning was echoed by the Rethink Mental Illness charity, which said cuts to funding for mental health services were costing lives.

In response to the innumerable cases revealing that NHS and social care services can no longer provide basic services, Conservative Health Secretary Jeremy Hunt callously dismissed any such claim. Instead, he attacked the thousands who use A&E departments—unable to get GP appointments and hospital referrals and find themselves in crisis—as “frankly selfish.”

Prime Minister Theresa May, attempting to divert attention away from the crisis ripping apart the NHS, pledged to prioritise mental health services. However, she failed to mention the impact on mental health due to her government’s overall assault on the welfare state, as well as the proven link between mental health and job insecurity, low wages, poor housing and benefit reform.

A 2014 report by the Faculty of Public Health (FPH) charity linked the rise in the number of mental health patients to the economic crash of 2008. The FPH describes itself as a “standard setting body for specialists in public health in the United Kingdom” and a “joint faculty of the three Royal Colleges of Physicians of the United Kingdom (London, Edinburgh and Glasgow) and also a member of the World Federation of Public Health Associations.”

The report said the UK is experiencing “a prolonged economic downturn with rising unemployment and uncertain recovery since 2008.” It added, “Economic crises increase the risk factors for poor mental health (poverty and low household income, debt and financial difficulties, poor housing, unemployment and job insecurity).”

It added, “There is evidence to suggest that the UK recession may result in an increase in mental health problems and lower levels of wellbeing, with a widening of inequalities.”

Labour’s Shadow Health Secretary John Ashworth attacked the Conservative government for this crisis and appealed to Hunt, May and Chancellor Philip Hammond to pledge more funding to prevent a repeat of recent events.

Ashworth called for a new funding settlement for health and care in the next budget “so this year’s crisis never happens again.” He said May should commit to bringing forward £700 million of social care money to help hospitals cope this winter.

While Ashworth criticised May for “not shining a light on cuts to mental health services,” no mention was made of the track record of the Tony Blair/Gordon Brown Labour governments—which laid the basis for today’s disaster by launching the huge cuts now wrecking the NHS and inaugurating privatisation policies. Labour introduced the private finance initiative (PFI) into the NHS, resulting in hospital closures, shortages of staff and ward closures—as hospitals faced huge debts paying off PFI mortgages.

This was overseen by the health trade unions such as Unison and Unite—with the co-operation of Labour councils—ensuring that any opposition by the working class to the breakup of the NHS and what remains of the welfare state was sabotaged.

The unions have not led a single successful struggle to prevent the closures of hospitals, cuts to social care services and savage benefit reforms—nor will they. Their role is to prevent any independent action to fight back against the destruction of the NHS and every social gain won over generations.

Death toll mounts as UK National Health Service deliberately destroyed

By Robert Stevens and Chris Marsden

Years of spending cuts have been used to intentionally bring about the destruction of the National Health Service (NHS).

At the weekend, the British Red Cross said the NHS was facing a “humanitarian crisis.” Its statement follows the deaths of two patients in Worcestershire Royal Hospital corridors while waiting for treatment. According to the BBC, a woman died of a heart attack after waiting for 35 hours on a trolley in a corridor. A man suffered an aneurysm after a long wait on a trolley, and, despite being treated, could not be saved.

The Daily Mirror reported that in recent days, a man was found hanged in a toilet cubicle at the hospital and may have been “accidentally strangled” by a drip feed cord.”

The deaths all occurred between New Year’s Day and January 3.

Some patients are waiting even longer for treatment, with John Freeman telling the Guardian that his 66-year-old wife Pauline waited for 54 hours on a hospital trolley in Worcestershire after suffering a stroke.

However, the situation in Worcestershire is only a microcosm of that facing the entire NHS. The chief executive of the British Red Cross, Mike Adamson, said, “[We are] responding to the humanitarian crisis in our hospital and ambulance services across the country. We have been called in to support the NHS and help get people home from hospital and free up much needed beds …”

Hospitals are increasingly forced to close A&E departments to patients. In December, more than a third of health trusts in England (52 of 150) issued an “alert,” meaning they required urgent action in order to cope. Seven of the trusts could not provide comprehensive care. In the county of Essex, with a population of more than 1.4 million, every hospital was forced to issue a “black alert”—the highest level—in the last few weeks. Nationally emergency departments closed their doors to new patients more than 140 times in December. Last week, ambulances on 42 occasions had to be diverted to other hospitals due to A&E’s not allowing in more patients.

The weekend’s events and the Red Cross declaration prompted a torrent of media comment and government rebuttals. Typical was the Observer, which editorialised, “The government must get a grip” because the “NHS is facing unprecedented strain.”

Prime Minister Theresa May replied, “I don’t accept the description the Red Cross has made of this,” while Education Secretary Justine Greening said the comments made were “inappropriate” because Red Cross involvement was “not particularly unusual”!

Professor Keith Willett, NHS England’s director of acute care, said “on the international scale of a humanitarian crisis, I do not think the NHS is at that point.” His defence is based upon comparing Britain with war-torn countries, as made explicit by Conservative health select committee chair Sarah Wollaston who declared baldly, “This is not equivalent to Syria or Yemen.”

In fact, just as with the imperialist-inspired wars in the Middle East, the crisis facing the NHS is a product of deliberate governmental policy.

In 2012, the health service of another country, Greece, was also described, by Doctors of the World, as being in a humanitarian crisis. There, too, brutal austerity cuts were to blame, as spending was slashed according to the dictates of Greece’s creditors and the world’s banks by more than €5 billion—almost a third—by the social democratic PASOK and Conservative governments. This offensive continues under the pseudo-left Syriza government, which pushed through a further €350 million in health cuts in 2016.

Britain has suffered cuts—in terms of a real-terms fall in wages the UK is second only to Greece—which have eviscerated the NHS and other vital services so that the Red Cross reported of Britain, “We’ve seen people sent home [from hospital] without clothes, some suffer falls and are not found for days, while others are not washed because there is no carer there to help them.”

During the 2010-2015 Conservative/Liberal Democrats government, billions in spending cuts to the NHS were imposed. A further £22 billion, again under the guise of “efficiency savings,” is to be slashed in this parliament to 2020. These cuts are to be implemented through new Sustainability and Transformation Plans being drawn up by health trusts in England, aimed at destroying the NHS and opening the doors to private health care that would be adequate only for the privileged few who can afford large contributions.

Having set the NHS up to fail, the government and the media will inevitably unite to insist that the answer to the present crisis is for the NHS to be made more efficient through the closure of “failing” services and additional privatisation measures.

In these circumstances, the response by Labour leader Jeremy Corbyn is politically criminal.

He demanded that May answer urgent questions on the NHS, as Parliament returns after its recess today, and lay out her plans to “fix” it. He did so while declaring that this crisis was “made in Downing St. by this government—a crisis we warned them about.”

Corbyn’s statements are shot through with hypocrisy. In the first instance, he presents the NHS crisis has having nothing to do with the policies of previous Labour governments led by Tony Blair and Gordon Brown—backed by most of the MPs in his party. Then he makes great play of his role in warning the government.

Rather than offering advice to May and her predecessor Cameron, the millions of health workers who supported Corbyn as Labour leader based on his pledge to end austerity had every right to expect him to fight the government on their behalf. Instead, Corbyn has stood by as every struggle by health workers in opposition to these attacks has been sabotaged by the trade unions and their Labour allies.

Last year, 50,000 junior doctors mounted a wave of unprecedented strikes to protest the government enforcing an inferior contract and as a way of halting the ongoing destruction of the NHS. In March last year, junior doctors accused Corbyn of ignoring their fight, even when it came to the ritual of Prime Minister’s Question Time. Jeremy Corbyn’s official spokesman admitted to the Daily Telegraph that Corbyn had indeed “decided to focus on other issues rather than question the Prime Minister over the strike.”

Corbyn responded by belatedly making a face-saving appearance at a picket line in April, while calling for the government to reach a negotiated settlement with the British Medical Association. His ally Diane Abbott issued a “jam tomorrow” statement to the Guardian August 24, pledging a future Labour government would “rescue the NHS,” by allowing “its budget to grow in line with the economy” and “shift[ing] resources to frontline care” by “bearing down on the costs of the private finance initiative (PFI)” rather than ending privatisation.

The end result was to facilitate the isolation of the dispute by the health unions and the Labour Party and a sell-out by the British Medical Association.

In 2012, the Socialist Equality Party launched the NHS FightBack campaign warning that “the destruction of the National Health Service as a universal and comprehensive service free at the point of delivery” was underway. In order to defend public health care as a social right, not a privilege, the working class must begin to organise a counteroffensive against the government, which must be waged independently of Labour and the trade unions on the basis of a socialist programme.

Dorset NHS management pushes health cuts amid growing opposition

By Ajanta Silva

Hundreds of patients, hospital workers and members of the public recently demonstrated in Poole against the slashing of health services in the county of Dorset, England. The rally was called by the Keep Our NHS Public (KONP) organisation.

This followed a protest by thousands of people and hospital staff who marched against the closure of the Kingfisher ward and Special Care Baby Unit at Dorset County Hospital this summer.

Tens of thousands of people have given their verdict on proposals by Dorset Clinical Commissioning Group (CCG) to gut public health services by signing petitions opposing them and taking part in protests.

Dorset CCG, which faces an annual £158 million deficit by 2021 due to Conservative government National Health Service (NHS) funding cuts, revealed its plans in a recently published “Clinical Services Review” (CSR). It aims to downsize two major Accident and Emergency (A&E) departments in Poole and Dorchester and close children units, maternity units and more than a half dozen community hospitals delivering inpatient care.

Thirteen community hospitals, which mainly operate as rehabilitation units and significantly lessen the pressure on acute hospitals, are going to be replaced with a handful of “Community Hubs,” many without beds. According to the CSR, three community hospitals—St. Leonards, Alderney and Westhaven—will shut and the sites will be used for “other purposes.”

Dorset CCG is carrying out a simultaneous review of mental health services called “Mental Health Acute Pathway” and “Primary Care Strategy” for General Practices (GPs, doctors’ surgeries). One can expect nothing but a further destruction of services from these. Mental health services will see attacks on what remains of the scarce facilities in the county, following the closure of Kings Park Hospital mental health unit in Bournemouth and the Chalbury Unit for highly specialised dementia needs in Weymouth. Shutting Alderney Community Hospital will also threaten two mental health wards.

The GP review takes place under conditions in which GP services are being slashed nationally. Last month, a leaked NHS England letter revealed the government wants struggling GP surgeries to be allowed to fail and “wither by the system.” At the same time, a pilot Uber-style private GP service, Doctaly, is to be rolled out nationally

Dorset’s population of more than 750,000 are going to lose hundreds of inpatient beds, despite acute hospitals already being overwhelmed with high inpatient volumes. Hospitals are already struggling due to lack of beds, staff shortages and scarce resources.

These devastating proposals, hatched behind closed doors over the last two years, are to undergo a bogus 12 weeks “public consultation” exercise in November before being implemented early next year. The CCG has already despatched its public relations agents to sell the proposals to NHS workers, with some meetings being held with the tacit support of the trade unions. The AGM of the Royal College of Nursing (RCN) Dorset branch, held in Bournemouth Hospital last month, featured a guest CCG speaker brought in to “explain” the plans.

The CCG’s promise to improve community integrated services is lip service, as the scrapping of community palliative services in Poole and Bournemouth has vastly increased the workloads of already shrunken district nursing teams and other community intermediate teams. Their claim to have “more care home beds in community” is equally a fraud, as such facilities do not exist and there are no concrete proposals to build them in the CSR. They expect nothing but having beds from privately run care homes, further outsourcing the services.

The CSR has nothing to do with providing improved, well-funded health services. Rather, it is a mechanism of NHS management in Dorset to impose its share of cuts, as part of the government’s overall plans to extract £22 billion in “efficiency savings” from the NHS via its Sustainability and Transformation Plans (STPs). England has been carved up into 44 “local health and care systems,” each of which has to submit cost-cutting STPs. That this is the aim was revealed when NHS Providers CEO Chris Hopson called for a debate on what services ought to be sacrificed.

This was a cynical announcement designed to cover up the fact that rationing of vital health services by CCGs is already the order of the day. Many hospital trusts are being forced into mergers, leading to loss of services and jobs. A&E departments, maternity units, heart units and ambulance services are facing downsizing or closures across the country.

Many CCG board members nationally, who have business interests in private companies, intend to exploit the opportunity to enrich themselves at the expense of patient care, as well as pay, terms and conditions of health workers.

Parallel to the CSR in Dorset, a “review” in Cumbria has come up with similar draconian cuts to NHS services in order to curb the looming deficit of £163 million a year by 2020. Its plan, too, includes the removal of consultant-led maternity care from the West Cumberland Hospital in Whitehaven and closing down three community hospitals—Alston, Maryport and Wigton.

In one case, leaked STPs show that in north-west London, 500 hospital beds are to be cut.

In West Yorkshire, there are proposals to close the equivalent of five wards in the Leeds Teaching Hospitals Trust and a “major reconfiguration” of frontline NHS services in Wakefield, North Kirklees, Calderdale and Huddersfield.

In the West Midlands region, there are plans for major changes to frontline services at Midland Metropolitan Hospital, including the closure of the hospital’s A&E unit and the closure of two District General Hospitals as part of a planned merger.

Growing opposition from clinicians, other hospital staff and people across Dorset County further repudiates the claims of the CCG that their plans are a product of the views of clinicians and the public that they met over the last two years during their “road shows.”

The fact is many clinicians and members of the public did not even bother taking part in these bogus consultations, already knowing that the outcome would disregard their views with the plans imposed anyway. The CCG admits in a bullet point in the document: “number of responses not high enough to be conclusive.” Even with a limited public engagement, they could not find any support to slash services. Instead, they found “strong support for care closer to home.” Hence, with these attacks the CCG is trying to enforce the opposite of what those who responded asked for.

The reorganisation plans of Dorset CCG, as in other parts of the country will inevitably deepen the plight of patients, including the most vulnerable sections of society, and continue to worsen the pay and conditions of its 31,000 workforce.

Workers and young people throughout Dorset, alongside hospital workers, have as in other areas nationally shown their desire to fight back against these attacks. The government is only able to impose its agenda, aimed at the break-up and privatisation of public health care, due to the treacherous role played by the trade unions and the Labour Party.

They have done everything possible to avoid a unified offensive of the working class against slashing of services. Unison, Unite, GMB and other health unions have not only been silent over the cuts in Dorset and nationally, they are complicit in implementing them.

KONP trades the illusion that the NHS can be defended by appealing to the very politicians who are committed to its destruction. KONP, which gravitates around the Labour Party and includes members of various pseudo-left outfits, backs the NHS Reinstatement Bill brought by the Labour in July. The Bill called for a reversal of the recent attacks made on the NHS by the Tory government. However, fewer than 50 MPs turned up to debate the Bill, which was presented as restoring the NHS to public ownership, ensuring it fell. Those not present included Labour’s “left” leader Jeremy Corbyn, and his close allies John McDonnell and Dianne Abbott.

Hospital workers, patients and working people in Dorset and throughout the UK must turn to the building of action committees, independent from the unions, to wage a genuine political struggle against these attacks and the Tory government carrying them out.

North Manchester National Health Service Trust struggling to cope

By Dennis Moore

A report by the Care Quality Commission (CCQ) on the state of one of the leading hospital Trusts in the north-west of England reveals the impact of years of cuts to the National Health Service (NHS).

The Pennine Acute NHS Trust runs one of the largest acute trusts in the UK, covering a population of some 820,000 people. It operates from four main sites including North Manchester General Hospital (NMGH), the Royal Oldham, Fairfield General and Rochdale Infirmary.

The CQC inspection took place between February and March, with concerns raised as to understaffing in a number of departments that broke national guidelines and a lack of staff training. It concluded that the Trust was inadequate.

Concerns were raised as to the length of time patients had to wait in all three emergency departments. CQC inspectors found that levels of understaffing were appalling, putting patients’ safety at high risk.

Serious deficiencies were found in maternity care, with some staff accepting low levels of care as the norm. These problems were mirrored in two separate reports that flagged failures in clinical leadership.

At the time the inspection took place, there were 170 serious maternity and gynecology incidents that had yet to be dealt with. Thirteen of these involved critical injury or death.

Staff shortages on maternity wards were highlighted, including 20 midwife vacancies. The numbers of staff did not meet national benchmark standards due to the reduction of the number of midwives. This resulted in hospitals not always being able to provide one-to-one care for women in labour as is standard practice in midwifery.

Staff shortages led to high levels of stress, and sickness rates, increasing dependence on bank and locum staff.

There were issues raised about the lack of adequate staffing, covering a number of different departments. At North Manchester General Hospital there was only one consultant on staff in the emergency department at the time of the inspection. The department is supposed to have nine consultants. There were only half the staff doctors that were needed and five of the 13 junior doctors required. This led to the accident and emergency (A&E) departments becoming overly dependent on locum staff. Figures from the Trust show the staffing problems in the A&E department at NMGH, with nearly a third of medical staff positions being vacant.

In all three A&E departments there were concerns raised as to the length of time patients were having to wait. Patients are supposed to be seen within four hours and hospitals can be fined £120 for breaching this time limit. Half the serious incidents in the trust between April and October—146—involved waits of 12 hours or more by patients.

Up to six months prior to March 2015, 70 percent of the shifts had been filled by temporary locums. The CQC raised questions as to the lack of performance monitoring of locum staff and their inductions.

An induction process was in place for locum staff. However, at the time of the visit, one of the doctors had not gone through this process. Instead the doctor had to rely on nursing staff to be able to locate key items and equipment.

The scale of the staffing crisis is so great that NMGH’s A&E department has considered diverting ambulances elsewhere at night. The report showed a catalogue of problems, with understaffing high on the list.

The lack of staffing in specific departments makes it impossible for staff to reliably deliver safe and effective services. While pointing to the impact of the staffing shortage, the CQC report recognises that in many areas of care across the trust staff were doing their best under these circumstances and were competent and compassionate.

At NMGH, the CQC found that annual staff appraisals were not being carried out. Appraisals are an intrinsic part of staff development and a method of being able to improve standards in clinical care. As low as 23 percent of staff received annual appraisals, effectively denying most staff the opportunity to meet with line managers to discuss issues such as performance.

Induction procedures were in place that would include the opportunity to develop skills and competencies, yet it was clear that due to manning pressures these plans were not always adhered to so that staff often were forced to take on roles sooner than anticipated.

Numerous incidents reported throughout the Trust, as a result of issues highlighted in the report, have led to compromising patient safety and care. This has been costly to the Trust. In 2014-2015, the Trust had the second highest level of clinical negligence claims cases against it nationally.

As in all trusts there will be cases of medical negligence. This can only be compounded by the conditions under which many employees in the NHS are forced to work on a day to day basis.

As the CQC report notes, such conditions are becoming intolerable. It cited one experienced worker in the women’s and children’s services, that includes maternity and pediatrics, who said the numbers of registered nurses on shift in her department had continually dropped over the last few years—meaning staff do not have time to do their jobs properly. Those that remain are terrified of missing the key details they are trained to look out for, but they are under so much pressure they can’t even stop for a glass of water.

The overall situation with NHS staffing is likely to get a lot worse. In the last fiscal year, Trusts ran up a collective deficit of £2.4 billion—with the Conservative governments’ aim to make further significant cuts to budgets.

A report published by the Kings Fund think tank warned that in attempting to balance the books, staffing levels will have to be reduced and waiting time targets relaxed—compromising patient care.

At the same time, there has been a massive growth in the private sector within the NHS due to competitive tendering and outsourcing. This has led to a bonanza for private companies winning lucrative contracts to deliver services. Companies such as Virgin Care and Care UK won contracts in 2014/15 worth more than £3.5 billion, five times greater than the previous year.

By last summer it was reported that three in four NHS hospitals were rated as inadequate. By July this year, a total of 26 Trusts under NHS England had been rated as ‘inadequate’ by CCGs.

The slashing of the NHS’s budget by £15 billion in the last parliament and a projected £22 billion in this one is the central cause of Trust’s being rated as failures. This situation is being utilised in order to justify further health care cuts and closures of hospitals.

To facilitate closures and cuts NHS England has divided England into 44 areas, each of which has to submit cost cutting Sustainability and Transformation Plans (STPs). In July, every hospital trust was sent a letter by Bob Alexander, director of resources at NHS Improvement, the health service’s financial monitoring department. The letter instructed trusts to identify departments, with a deadline of July 31, which could be “re-provided” by other institutions. The submitted plans must include a list of services that are “not clinically and financially sustainable.” A department being “re-provided” is a euphemism for its privatisation.

 

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UK: Further National Health Service hospital closures and cuts to be imposed
[3 September 2016

Dorset health services to be slashed to reduce deficit

By Ajanta Silva

A major shakeup of National Health Service (NHS) facilities in Dorset, England is being planned in which two accident and emergency (A&E) units, a maternity unit, a children’s ward and several community hospitals will be closed or downsized.

As is always the case with such cuts, the bitter pill is being sugar-coated by PR experts and presented as a golden opportunity to “deliver care closer to home,” “increase the number of people supported in the community as an alternative to major hospitals,” and “increase the range of services in the community.” The reorganisation is portrayed as fulfilling the Conservative government’s pledge of providing “seven day services” in the NHS.

In a statement totally disconnected from the real world of austerity, budget cuts and privatisation, Dorset’s Clinical Commissioning Group (CCG), one of 211 organisations responsible for organising the NHS in England, proclaims the proposed changes in its “Clinical Services Review” will ensure that the public will “continue to have high quality, safe and affordable care both now and in the future.”

What the CCG does not discuss is that the changes are driven by the government’s policy of starving the NHS of funds in order to create favourable conditions for the privatisation of services. The 2010-2015 Conservative/Liberal-Democrat coalition granted the lowest ever funding increase for the NHS in its entire history, and imposed £20 billion in “efficiency savings” cuts.

The current Conservative government is demanding further cuts of £22 billion. As a result, one CCG after another is falling into deficit, with nine CCGs and five major hospital trusts recently forced by NHS bosses into “special measures,” under which they have to draw up an
action plan to meet stringent budget targets.

Dorset CCG claims it is facing a £200 million deficit by 2021. Currently, it is seeking approval for its reactionary proposals, hatched behind closed doors over the past two years, from the Wessex Clinical Senate (a non-statutory advisory body providing independent clinical advice for the Wessex area, including Dorset, Hampshire and the Isle of Wight) and from NHS England. Then the proposals will be put out for the obligatory, but bogus, “public consultation” exercise before the reorganisation begins in earnest next year.

The plans include:

* The closure of three community hospitals—Alderney, Westhaven and St Leonards—and three others shut or downgraded to “community hubs” without beds to meet the CCG target of “7 strategically located sites with beds compared to 13 at present.”

* The slimming down of A&E departments at Poole General Hospital and Dorset County Hospital in Dorchester and the concentration of A&E at Royal Bournemouth Hospital.

* The possible closure of Paediatric and Neo-Natal care units at Poole General hospital as a result of the A&E downgrading.

* The shutdown of St Mary’s maternity unit in Poole.

* The closure of the remaining day hospital and rehabilitation units at Christchurch hospital, which means that all wards, with the exception of the MacMillan cancer unit, will disappear.

* A reduction in children’s services in Dorset County Hospital with the threatened closure of Kingfisher ward and the Special Care Baby Unit. Stroke care and emergency surgery at the same hospital will be reduced from 24 hours to 14 hours a day.

* Further privatisation of services, indicated by language such as “short-term beds in care homes could be used as an alternative to community hospitals in areas where the need is small,” and the recent closure of Ward 9 at Bournemouth Hospital, which had 35 beds, at the same time that beds available for private patients are increased.

* Increased pressure on already struggling Mental Health Services, which has already included the 2013 closure of Kings Park Hospital in Bournemouth with the loss of more than 40 beds, plus the elimination of day clinics and day hospitals that support individuals across the county. Recently shut down was the Chalbury unit in Weymouth, which looked after dementia patients with highly specialised needs.

* Making health workers redundant or redeployed to other places against their will under the “fit for the future” proposals.

On top of this are the disastrous implications of the threatened imposition by the Conservative government of an inferior contract on junior doctors. This is opposed by the doctors as being unsafe for patients and detrimental to pay, terms and conditions.

The closure or downgrading of community hospitals, which are often rehabilitation units closely integrated into their local communities, undermines the vital role they play in avoiding admissions to and facilitating early discharges from acute hospitals. The changes belie the CCG’s talk about “care closer to homes.”

The slashing of services at the already overwhelmed A&E departments in Poole and Dorset will put enormous pressures on the remaining one at Bournemouth, and cutting maternity units and children units will have a crippling effect on patient safety and care.

The concentration of services in the Bournemouth and Poole conurbation in the east of Dorset, home to 450,000 of the county’s 750,000 inhabitants, will involve longer journey times and inevitably lead to excessive deaths. People reliant on public transport are already facing difficulties, with many rural areas in the west having no proper services at all. This situation means that at some hospitals, staff are already unable to work early shifts or at weekend because of the lack of transport.

The CCG attempts to justify this “streamlining” on the grounds that well-resourced but fewer units would improve care and the longer ambulance transport times would be offset by the presence of trained professionals. However, in May, the South West Ambulance Trust, which operates across Dorset, was issued a Warning Notice by the Care Quality Commission for the inadequacy of its 111 call service and told to make “significant improvements to protect the safety of patients.”

The inspection found that “there were often not enough staff to take calls, or to give clinical advice when needed.” It added, “Staff reported working long hours, many feeling high levels of stress and fatigue. There was a high staff turnover and high sickness rates. Too many calls were abandoned, and patients were waiting too long for their calls to be answered and to be assessed, or to receive a callback with appropriate advice.”

Many clinicians are rightly outraged by the CCG plans, and the thousands of people who marched against the closure of the Kingfisher ward and Special Care Baby Unit at Dorset County Hospital this summer are just one expression of the opposition that is brewing.

Parliamentary petitions against the shutting of A&E departments have attracted nearly 50,000 signatures.

Dorset CCG is opposing criticisms of its proposals with the response that they are “the result of ongoing engagement with local clinicians” and the public during road shows.

The attack on health services in Dorset is not unique. CCGs across the country have started rationing vital services, including knee, cataract and hernia surgeries and IVF treatment, with the ultimate aim of expediting the privatisation process. The CCGs, with their control of £100 billion worth of NHS funding, are a goldmine waiting to be plundered.

According to a report published by the Unite trade union last year, more than a quarter of the 3,392 CCG board members have links to a private company involved in health care, including 513 company directors and 140 business owners.

Although Unite publishes such incriminating information about the destruction of the NHS, it, along with Unison, the largest public sector union, GBM and Royal College of Nursing are doing nothing to oppose the attacks on health services in Dorset. Given their record, there is no doubt that they will work to sabotage any struggles that erupt in opposition to the slashing of services in order to steer them into safe channels and not challenge the capitalist profit system that is responsible for these attacks.

Workers in the health service, in alliance with those relying on these critical services, must prevent this by mobilising independently of the unions and forming committees of action.

UK National Health Service forced to the brink of financial collapse

By Margot Miller

The National Health Service (NHS) in England is facing a “colossal financial challenge” and “cannot deliver the required services to patients and maintain standards of care within the current budget.”

This is the damning conclusion of “Impact of the Spending Review on health and social care,” a report released July 23 by the House of Commons Health Select Committee. It underlines the parlous state of NHS finances due to endless cuts and indicates that the health service is facing an existential crisis.

The report examines the effect of the Conservative government’s spending review last autumn on health and social care and its impact on the NHS England’s Five Year Forward View strategy document. The strategy document was published by NHS chief executive Simon Stephens in 2014 and identified a projected £30 billion funding gap by 2020-2021. Stephens is a former Labour Party councillor, who later became an adviser to former Labour Prime Minister Tony Blair. The strategy was promoted as a panacea for eradicating inequality in health outcomes between the rich and poor. The most deprived people, for example, can expect to live in good health nearly 17 years less than their least deprived counterparts do.

In last year’s Spending Review, great play was made of then Tory Chancellor George Osborne’s announcement that the NHS would receive an additional £8.4 billion to plug the funding gap. That figure was a lie as even Health Select Committee chair and Tory MP, Dr. Sarah Wollaston, acknowledged. Wollaston said the “increase in health funding is less than was promised by the usual definitions.”

Total NHS spending will in fact rise by just £4.5 billion—half the amount Osborne announced. The rest includes money diverted to NHS England from the Public Health grant to Local Authorities and Health Education England.

However, to even talk about an increase in spending on the NHS is misleading. To plug the funding gap, the NHS has been instructed to make savings of £22 billion by 2021, on pain of fines and takeovers by regulators.

Accepting the overarching strategy of the ruling elite that “efficiency savings” are required, the Five Year Forward View advocated Preventative Medicine as the key to realising these savings. However, the Public Health budget, which finances preventative health, is set to shrink from £3.47 billion this year to £3 billion by 2020/21.

The Select Committee concludes that neither the government nor NHS managers can provide “sustainable” ways of meeting the rising deficits.

The Select Committee findings are no less bleak when it comes to the training of new staff. Its assessment that Spending Review cuts on Health Education England come at a time when the “workforce shortfall is already placing a strain on services and driving higher agency costs” is an indictment of the criminal operation now underway to wreck the NHS.

The report describes how cuts in training for new doctors and nurses have led to staff shortages and reliance on more expensive, agency staff and that “We are deeply concerned about the effect of the cuts on the training budgets,” which takes effect next year. Nurses instead will have to fund their own training and living expenses by taking out loans, leading to debts of up to £52,000.

With one in three nurses due to retire in the next five years, and one in 10 nursing posts unfilled, ending bursaries will inevitably make worse the huge crisis in the supply of NHS staff.

The Select Committee report also expresses what is obvious to all—that the NHS cannot implement the seven-day service in hospitals and GP (General Practitioner) surgeries demanded by the government, “given the constraints on NHS resources.”

The imposition of seven-day working without the necessary extra funding has met with huge opposition from health workers and the public. Junior hospital doctors have taken days of strike action, for the first time ever, against an inferior contract that increases their hours without remuneration and compromises patient safety. They recently rejected the British Medical Association’s (doctors’ trade union) recommendation to accept the government’s final offer before they imposed the new contract.

In Reviewing Social Care, the Select Committee writes that “historical cuts to social care funding have now exhausted opportunities for significant further efficiencies in this area.” In other words, and like most other sectors in the NHS, Social Care has been cut to the bone. In what the report refers to as “delayed transfers of care,” the discharge of old people from hospital after treatment is often delayed, because there are not enough places in recuperative care homes.

The report’s final verdict on Social Care is that “increasing numbers of people with genuine social care needs are no longer receiving the care they need because of a lack of resource.”

In relation to provision for Mental Health Services, the Select Committee warns that promised extra money to achieve parity for this poor relation “could get sucked into deficits in the acute sector.”

Not only are services being cut now, but funds earmarked for facilitating the changes outlined in the Five Year Forward View are being used to cover current account deficits. The budget for capital projects is also being raided.

Hospitals have been told by NHS England that they need to take whatever action is necessary to tackle the £2.5 billion deficit this year, the largest aggregate deficit in the history of the NHS. An example of the destruction this is leading to is at Stepping Hill Hospital in Stockport, northwest England, which due to a £40 million deficit is preparing to shed 350 jobs out of total staff of 5,000. In Scotland, Tayside health chiefs are planning cuts in jobs and services over the next five years to tackle a deficit of £175 million.

Such is the determination of the government to impose austerity that Health Secretary Jeremy Hunt, one of the few Tory senior cabinet members to retain his post after Prime Minister Theresa May took up office last month, has instructed NHS England to abandon long-established NHS treatment targets. Waiting times for Accident and Emergency treatment and cancer referrals will be relaxed and hospitals have been told to ignore previous safety guidelines regarding staffing levels. One nurse per eight patients now no longer constitutes the absolute minimum safety level, but is the maximum ratio allowed.

A picture emerges of an NHS near collapse. For the ruling elite, its answer is more of the same. The House of Commons Select Committee concludes, “If the funding is not increased, there needs to be an honest explanation of what that will mean for patient care and how that will be managed.”

Department of Health Director Pat Mills is more forthright—that patients may have to pay to use the NHS by 2025.

Though making a hard-hitting assessment of the crisis overwhelming the NHS, the parliamentary report was a fraudulent exercise. It is a part of a softening up process to prepare the population for the break-up and destruction of the NHS. The report does not and cannot offer any progressive solution to the funding crisis, because the Select Committee that wrote it comprises MPs from the very parties, including Labour, whose policies have led the way in attacking the NHS.

National Health Service cardiac units to be cut

By Margot Miller

In a major attack on the National Health Service, from April next year NHS England will no longer commission complex heart surgical procedures from three major hospitals. Non-surgical cardiac procedures will end at five other hospitals.

The axe will fall at the CHD (congenital heart disease) units at the Glenfield Hospital in Leicester, the Greater Manchester University Hospital NHS Trust and the Royal Brompton and Harefield Trust in London.

This will reduce the number of units in the country dealing with congenital heart disease—a condition that mainly affects children—from 13 to 10.

Only four units that deal with less invasive procedures will remain out of nine, with closures falling at Blackpool Teaching Hospital NHS Trusts, the University Hospital South Manchester, Papworth Hospital Cambridgeshire, Nottinghamshire University Hospitals Trusts and Imperial College Healthcare in London.

CHD affects nine out of every thousand children born in the UK, with conditions such as hole in the heart, narrowing of the aorta, restricted blood flow to the lungs and defects in heart valves. Four thousand such complex operations are performed a year. While the condition mainly affects children, some adults also require treatment.

The last attempt to cut these services collapsed three years ago amid lawsuits and judicial reviews, such was the outcry from hospital management, staff, parents and the public. NHS England, the body that oversees the budget, planning and day-to-day operation of the commissioning side of the NHS, as set out in the Health and Social Care Act 2012, was given the job of imposing the cuts.

In 2015, NHS England published new guidelines that CHD units had to meet in order for the organization to continue commissioning their services. The new “standards” require each cardiac surgeon to perform 125 operations each year to remain sufficiently skilled, with each hospital team required to have at least four surgeons on the rota. Only two of the existing 13 CHD unit hospitals, the Birmingham Children’s Hospital and Great Ormond Street London, satisfy all the criteria.

Propagandising on behalf of the cuts, the right-wing Daily Express claimed the proposed closures were due to “concerns over standards of care.” It claimed the Manchester hospital does “not meet the standards and is assessed as not being able to in the foreseeable future,” due to having only one CHD surgeon. The Telegraph headlined its article, “One in three children’s heart surgery units to be cut due to safety fears,” while the BBC declared that the hospitals have been ordered to stop providing complex cardiac care “amid concerns over standards.”

NHS England standards are arbitrary and are being used to justify the closures. It admitted in its review that all the CHD units in England provided safe care and mortality rates were within acceptable limits. However, they claimed that some units saw too few cases to maintain standards! Surgeons could easily visit other hospitals to share expertise and maintain their skills.

NHS England presented the cuts as a positive “rationalization” that brings to a close a 15-year battle to centralize CHD services, following high death rates discovered at the Bristol Royal Infirmary (BRI) in the 1990s. Professor Ian Kennedy, chair of the public inquiry into the scandal at the BRI, stated, “[W]e have waited 15 years to arrive at a solution which delivers quality and consistency for current and future generations.”

What happened at the Bristol Hospital is an example of how the NHS is first starved of funds, and then vilified when things go wrong to make way for privatization and more cuts under the pretext of rationalization.

In 1989, new consultant anaesthetist Stephen Bolsin, concerned about the high death rates of babies after surgery in the Bristol unit, embarked on a six-year comparative study that confirmed his fears. He eventually became a whistleblower.

The investigation into the scandal concluded that “in the period from 1991-1995 between 30 and 35 more children died after open heart surgery in the Bristol unit than might have been expected.”

Kennedy published his report in 2001, making 198 recommendations for improvements in the NHS—focusing on bureaucratic indifference and mismanagement—but had little to say about NHS resources. Yet it was clear that the lack of resources—and the struggle to acquire new ones in what, due to increasing “marketisation” and privatisation, was a highly competitive environment—played an essential role in events at Bristol.

As a result of the inquiry, two doctors were struck off the medical register and one disciplined. For his pains, Dr. Stephen Bolsin was unable to work again in the UK and has since taken an appointment in Australia.

NHS England was immediately challenged over the decision to cut CHD services. John Adler, chief executive at the Glenfield, Leicester hospital, said, “Our most recent clinical outcomes place us alongside the best surgical centres in England.” He expressed his concern at the dire implications, stating, “It is not clear what will happen to around 300 staff who work at the unit if it closes or where patients will be treated.”

Chief Operating Officer Robert Craig, speaking for the Royal Brompton and Harefield Foundation Trust, condemned the threat of closure of “one of the largest and most successful centres in the country” as an “absurd approach.” He also pointed out that stopping CHD surgery at the hospital would put other ancillary services at risk, such as paediatric intensive care, respiratory care and other heart services.

Dr. Jonathan Fielden, the director of specialised commissioning at NHS England, dismissed the anxieties parents face, saying if they want high quality care, they will be prepared to travel for it.

Right-wing Blairite Labour MP for Leicester Liz Kendall, who lost to Jeremy Corbyn in the 2015 Labour leadership contest, met the closures with a proposal to campaign to save the unit at Glenfield. As has been demonstrated countless times in the past, such localised campaigns only serve to pit hospital against hospital and NHS workers against each other.

By isolating workers on a hospital by hospital basis, the Labour Party and health trade unions paved the way for the closure of numerous NHS services over the last decade, including many Accident and Emergency departments. Since 2010, over 60 towns and cities across England have had vital hospital services either closed down or downgraded (meaning extreme “rationalisation,” often linked to nearby closures).

Junior doctors have rejected a union-backed attempt by the government to wind up their strike action and impose a new contract that will extend their hours and compromise patient safety. What is required is a coordinated response to defend all NHS Services. The defence of health care and every other basic social right can only be taken forward through a break from the unions and the Labour Party. Action committees must be formed by patients, hospital staff and the workers and youth whose lives and health are being jeopardised.

Many UK accident and emergency units closed or downgraded

By Harvey Thompson and Barry Mason

Since 2010, over 60 towns and cities across England have had vital hospital services either closed down or downgraded (meaning extreme “rationalisation,” often linked to nearby closures).

The wrecking of Accident and Emergency (A&E) and maternity units has proceeded across all regions, with dozens more currently under threat with decisions pending.

A&E units downgraded since May 2010 include four in London: Queen Mary’s Hospital, Chase Farm, Hammersmith and Central Middlesex Hospital. A further two A&E units in London at Ealing London and Charing Cross are threatened with closure/downgrade.

The region of Greater Manchester, with a population of 2.7 million, has lost services with more closures and downgrades threatened. Rochdale Infirmary A&E was downgraded in 2011 and the closure of Trafford Hospital’s A&E was approved in 2013. Trafford Hospital was where the National Health Service (NHS) was founded in 1948.

North Manchester Hospital, Fairfield Hospital and Tameside Hospital could lose emergency surgery services. Another three of four hospitals—Wythenshawe in Manchester, Stepping Hill in Stockport, the Royal Bolton and the Royal Albert Edward Infirmary in Wigan—could also lose emergency surgery departments.

Every week brings news of more threatened hospital cuts and closures. Last week it was revealed that essential services (A&E, baby care unit, maternity and stroke unit) at the North Devon District Hospital could go. In response, more than 4,200 people signed a petition to the government demanding the protection of the services. The A&E unit at the North Devon District Hospital is some 50 miles from the units at the Royal Devon and Exeter Hospital or the hospital at Taunton. The petition notes, “This needs to be halted as this will without doubt lead to deaths.”

The cases of the Calderdale Royal Hospital, in Halifax, and Huddersfield Royal Infirmary (HRI), both in West Yorkshire, are typical in terms of the impact of successive governments’ NHS privatisation policies and the strong opposition now developing.

In mid-January, the Calderdale and Huddersfield NHS Foundation Trust announced its plans to close the A&E department at the HRI in Huddersfield and concentrate A&E services in Halifax. Huddersfield is a concentrated urban area with a population of over 162,000; Halifax has a population of 95,000.

The proposals were marketed under the slogan “Right Care Right Time Right Place.”

On January 20, a panel meeting between the two clinical commissioning groups (CCGs) that cover Halifax and Huddersfield voted in favour of the proposal. CCGs were created under the Health and Social Care Act 2012 to speed up the privatisation process. Its members are drawn from local GP practices, and are responsible for commissioning health care services. They control around 60 percent of the total NHS budget.

Under the proposals, the current HRI building would be demolished, with a new “purpose built facility” constructed on the opposite side of the road. Both hospitals would have “urgent care centres,” but A&E would be concentrated at Halifax. The NHS Trust announced that following agreement of the two CCGs, there would be a 12-week consultation period beginning in February, and the trust would arrange meetings at which “members of the public will be invited to share their views.”

The January 20 meeting was informed of forecasts indicating Calderdale and Huddersfield NHS Foundation Trust would be £281 million in debt by 2020, but that by adopting the proposals to close the HRI A&E it would save £240 million.

Much of the accumulated debt is a result of the Private Finance Initiative (PFI) agreement used to build the current Halifax hospital. It was opened in 2001, but commissioned in 1998 under the auspices of the then Labour government of Tony Blair, which rapidly expanded the hospital building programme using PFI arrangements.

The new Halifax hospital, the Calderdale Royal Hospital, which was developed by the then Calderdale Healthcare Trust and private firm Catalyst Healthcare (Calderdale) plc, cost around £76 million to build. But the PFI will cost the present foundation hospital trust an astronomical £773 million over 60 years to finance.

In 2001, the Huddersfield and Halifax hospital trusts merged to form the current Calderdale and Huddersfield NHS Foundation Trust, which inherited the Halifax PFI debt burden. The decision to go for the closure of the Huddersfield A&E unit is related to the terms of the Calderdale Royal PFI agreement, which prohibits its sale or mothballing for another 42 years.

Following the announcement of proposals to close Huddersfield A&E, a local businessman, Karl Deitch, set up a Facebook page called “Let’s save Huddersfield A&E.” Within a few hours, more than 20,000 had signed up. This figure has more than doubled since, equivalent to almost a third of the entire town’s population.

Local MPs Barry Sheerman (Labour) and Jason McCartney (Conservative) also launched a petition campaign, which has been endorsed by the local Huddersfield Examiner, to get 100,000 names on the petition and prompt a nonbinding debate in Parliament.

A rally held in Huddersfield town centre January 23, organised by the Hands off HRI campaign, attracted around 1,000 people. The trade unions were conspicuous by their absence.

The political tone of the campaign was summed up by Deitch, who said, “We want as many people as possible to come down. … It’s going to be a nice, calm rally … It won’t be political—this is just about trying to save the A&E both here and in Calderdale …”

In Lancashire, hundreds protested April 30 for the third week running to demand that Chorley Hospital’s A&E department be re-opened.

The Save Chorley Hospital group vowed to stage a protest outside Chorley and South Ribble Hospital every Saturday until its A&E department reopens.

Lancashire Teaching Hospitals Trust announced three weeks ago that the department would be shutting from April 18 due to an acute staff shortage, particularly of junior doctors. Chorley Hospital has eight of the 14 doctors it needs and can therefore only staff less than half the hours required.

The downgrade means there is now an Urgent Care Centre, which cannot treat life-threatening conditions. The trust said there were “no other safe options” due to a shortage of doctors.

Ambulances will take emergency patients to other hospitals, including the Royal Preston Hospital, 14 miles away.

A parliamentary petition to keep the hospital’s A&E department open has since received over 18,000 signatures.

These myriad localised campaigns are an expression of the deep popular anger that exists in opposition to the destruction of the NHS. But as the junior doctors’ dispute demonstrates, left at this level and devoid of a political perspective on which to oppose the programme of the government, opposition will be suffocated by the trade unions and their allies in the Labour Party.

Junior doctors face political fight to save National Health Service

By Paul Mitchell

The 48-hour strike by junior doctors that began yesterday is their fourth industrial action in four months. National Health Service England reports that 5,165 operations have been cancelled as a result.

The British Medical Association has called another two-day strike on April 26 and 27. For this first time in the history of the NHS—which was founded in 1948—it will involve a “full withdrawal of labour” which “means that all junior doctors will not attend work, or provide emergency cover.”

Junior doctors have been demanding more effective action after Health Secretary Jeremy Hunt announced that he would impose a new contract by August 1, which will remove unsocial payments and reduce the safeguards against junior doctors working excessive hours.

The imposition of the contract is a test case for the restructuring of the terms and conditions of the 1.3 million workers in the NHS, who have already seen their pensions attacked and real wages slashed. At the same time, the Conservative government is driving through £22 billion in “efficiency savings” in the NHS budget over the next five years on top of the previous coalition government’s £20 billion in cuts. The lowest ever funding increase for the NHS in its history and the burden of Private Finance Initiatives (PFIs) have already led to huge deficits.

The greatest political danger facing junior doctors would be to underestimate what is at stake in their fight and to believe that the BMA’s limited action offers a chance of victory, especially given the role played by the rest of the trade unions and the Labour Party in isolating their struggle.

The aim of the Conservative government is not merely to cut wages, or step up exploitation. It is to destroy the NHS. As far back as 2005, Jeremy Hunt co-authored a policy pamphlet that called for the NHS to be replaced by an insurance system. “Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of health care in Britain,” he wrote.

To show how far the ruling class is prepared to go is indicated by the March 25 edition of the Daily Telegraph. Executive Editor (Politics) James Kirkup threatened the doctors not to repeat the “the mistakes of the miners’ strike” in 1984-1985. The BMA had to learn the lessons of what happened to the National Union of Miners, which “will soon slip into history; it will this year be legally wound up for lack of members.”

It was about time, he wrote, that workers realised that “the days of a job for life and a gold-plated pension were over… The future of work will mean freelance, flexible, footloose, economic free agents skipping from employer to employer, job to job.”

Kirkup’s favoured model, and that of the government if it was free to state so openly, is the production-line hospitals pioneered by Devi Shetty, according to the Wall Street Journal, “the Indian heart surgeon once called the Henry Ford of medicine.” These hospitals operate for a fraction of the cost in the West and employ surgeons working six-day weeks on much lower pay. Narayana Health is valued at US$1 billion.

The Wall Street Journal ’s glowing tribute is unintentionally a devastating indictment of private medicine. Noting that Naraya Health charges a fraction of the cost of open-heart surgery, “compared with hospitals in the US that are paid between $20,000 and $100,000, depending on the complexity of the surgery,” the Journal reports, “By next year, six million Americans are expected to travel to other countries in search of affordable medical care, up from the 750,000 who did so in 2007…”

Kirkup also pointed to George Washington University study that “estimates 85 percent of a typical doctor’s work can be done perfectly well by a ‘physician’s assistant’ with a fraction of the training or wages.”

His calls were taken up by the ConservativeHome blog, owned by Lord Michael Ashcroft, former deputy chairman of the Conservative Party and a tax-exile who appears in the recently leaked Panama Papers for making use of law firm Mossack Fonseca to set up his shell companies. Henry Hill advised Hunt on “How a Government can beat the BMA” to become “a modern-day Margaret Thatcher, bringing truculent trades unionists to heel and unleashing modernity on one of the UK’s totemic industries.”

Like Thatcher he should create a scab workforce—“some form of ‘Territorial NHS’, or Health Service Reserve, modelled on its military counterpart” who would “receive pay, training, and legal rights to take time out of their ‘civilian’ life to work for so many weeks of the year in the NHS.” He then echoed Kurkup’s call for “A larger, flexible pool of ‘physician’s assistants’ [who] would reduce the NHS’s dependence on full-time professionals.”

Hill called for the government to adopt a “blunt-force approach” and declare doctors to be an essential profession and forbidden to strike. Alternatively hospital trusts could be broken up into independent “legally-distinct employers,” which would end national strikes and drive down pay and conditions.

“One day”, Hill declared “the BMA will have their 1984… Conservative strategists owe it to themselves, and to the country, to lay the groundwork properly.”

On the same day as Hill’s article appeared, ConservativeHome published a piece by Lord Howard Flight, chairman of private equity company, Flight & Partners Recovery Fund, and a former Shadow Chief Secretary to the Treasury. Entitled, “We simply cannot afford to carry on protecting spending on welfare, the NHS and schools”, Flight’s article lamented the fact that after years of austerity, there was still “a £56 billion hole in the public finances, high government borrowing—over £72 billion this year—and a public sector debt standing at £1.6 trillion. It is obvious that the main areas of spending—Welfare at £240 billion, Health at £145 billion and Education at £102 billion will have to be constrained at some point.”

The BMA’s insistence that the junior doctors’ dispute is non-political is false to the core and, left unchallenged, will ensure only defeat. It is not a fight over pay, but to prevent the destruction of public health care and must be pursued as such.

The trade unions are opposed to this. They have played the key role in enabling the government to push its measures, making no attempt to link up the junior doctors with the nurses and midwives, who are opposed to the government decision to scrap NHS bursaries in 2017, or the struggle of any other group of workers, and making no appeal for solidarity action.

The BMA’s demand not to politicise the dispute is also supported by the Labour Party, which while in office from 1997 to 2010 began opening up the NHS to the market through schemes such as Independent Sector Treatment Centres and the Private Finance Initiative (PFI). The Labour Party has refused to officially back the dispute, with leader Jeremy Corbyn confining his remarks to criticisms of the government for provoking a protracted industrial dispute.

NHS Fightback, the political initiative of the Socialist Equality Party, has insisted that the junior doctors’ dispute underscores the necessity for the working class to strike out on a new political course, based upon the recognition that the defence of jobs, the attacks on pay and closures of hospital facilities cannot be taken forward through the trade unions and the Labour Party. It is time that junior doctors, other health care workers and their supporters begin to organise themselves independently in action committees to defend the NHS. The Socialist Equality Party must be built to provide leadership in this essential political conflict.