A&E provision threatened by PFI and mismanagement

Twenty-thirteen sees Aneurin Bevan's NHS turn 65. But instead of celebrating its birthday and striding onwards it faces vicious attacks which threaten its whole future.

Battle lines have been drawn in Cambridgeshire and the western Kent borders - areas which have links with protests in the past. Wat Tyler rebelled against feudalism and Oliver Cromwell fought the Crown. Today's enemies are just as tangible.

This week the fuse was lit for the wholesale privatisation of the service - and the government is as usual carrying out its backstabbing behind smoke and mirrors dished up by lackeys.

The NHS has for years become the theatre for dodgy ideologies such as the Tory "you don't get anything for nothing" mantra. And it has long been eyed by their money-grubbing mates as a potential honeypot.

Now the South London Healthcare NHS Trust is on course to be dissolved, a victim of PFI debt and Tory cuts.

It was the first trust to be placed in administration after it reached the brink of bankruptcy and now special administrator Matthew Kershaw, who was parachuted in to run the trust last summer, says it should be broken up.

Other organisations would take over the management and services - meaning hospitals not even part of the trust are being drawn into the plan.

Lewisham Hospital's A&E services, including its acclaimed children's A&E, medical and surgical emergency care and maternity services are all up for closure as part of a scheme to merge it with Queen Elizabeth Hospital.

The fact that Lewisham is not connected with the trust doesn't seem to matter. When have mere details ever got in the way of a Tory masterplan?

Labour's Dame Joan Ruddock said: "This cannot be justified - 120,000 use Lewisham A&E each year. Over 30,000 children use the children's A&E. Over 4,000 babies are born in the hospital each year."

Thousands of people in the area protested when initial recommendations trickled out last October and there was widespread opposition from health professionals and politicians. It looks as though residents will need to take to the streets again.

The trust was created in 2009 after the merger of three hospitals - the Princess Royal in Orpington, Queen Mary's in Sidcup and the Queen Elizabeth in Woolwich.

Now Kershaw says any debts - the trust was losing around £1.3 million a week - should be written off by the Department of Health so new organisations are not "saddled with the issues of the past."

This would include bailing out massive PFI debts, which use up 16 per cent of the trust's income.

The bailout would provide a tasty sweetener for any private firms hoping to cash in on its difficulties - though the experience of Hinchingbrooke hospital in Huntingdon hardly bodes well for private-sector involvement.

Ali Parsa, boss of Circle which at Hinchingbrooke became the first private firm to manage an NHS hospital, stepped down last month with its deficit twice as high as planned.

The Bromley Times has also pointed out that Kershaw himself has already gone £1m over his own budget.

Ominously, Kershaw said £42m could be saved by cutting 140 staff from the trust's three hospitals. Implementing his proposals would cost around £313m, while the trust's debts are expected to reach £207m by March.

Health Emergency chairman Geoff Martin says the trust has been "ripped to shreds" through a "lethal combination of mismanagement, the brutal cost of financing PFI schemes and an obsession with a 'target-led' culture at the expense of patient care.

"The bottom line is that the same poisonous cocktail is still at the heart of the NHS under this government. The collapse into bankruptcy at South London Healthcare could easily be mirrored in other parts of the NHS, notably at St Helier Hospital just across town in south-west London.

"Not a single manager or politician responsible for this disaster has ever been called to account for their actions and the misery and anger that they have unleashed."

Unison's branch treasurer at Lewisham hospital Conroy Lawrence says the plan to break up the trust is cost-driven.

"If you take millions out of the NHS as this government is doing then A&E departments, maternity units and hospitals will close," he says.

"We have every reason to believe the people of Lewisham will now redouble their efforts to defend what is a popular and well respected hospital against what is nothing less than a political attack upon an inner-city community."

And shadow health secretary Andy Burnham has said the review "takes the NHS into new territory.

"It uses powers passed by the previous government in a way that was never intended and in so doing sets a worrying precedent, whereby normal processes of public consultation are short-circuited and back-door reconfigurations of hospital services are pushed through."

He pointed out that Health Secretary Jeremy Hunt has "acknowledged that he needs to commission fresh legal advice - which seems to me to suggest there is a doubt about the legality of this process.

"Given that all A&Es in south London are currently overstretched and operating at full capacity, people will need to be convinced that these changes won't put lives at risk.

"This process is attempting to rewrite the rules on making changes to hospital services, bypassing the intention of this house," Burnham told Parliament.

"It will send a shiver through communities without a foundation trust as it raises the prospect that their hospital can be used as a pawn to solve problems in another."

Hunt is due to make a decision on the trust's future by February 1.