Hospital's future hangs in the balance

Jeremy Hunt will reveal the fate of Lewisham Hospital and services in a broad swathe of south-east London on February 1.

We know this because the timetable is laid down in the brutal Unsustainable Provider Regime, drawn up by Labour in 2008, which could yet be rolled out in other areas.

This laid down a forced march towards cutbacks, from the time of the appointment of trust special administrator Matthew Kershaw back in July, to address the massive financial problems of the South London Healthcare Trust.

Kershaw had 45 days to draw up his plans to deal with the £200 million cumulative deficit, the £60m-a-year losses and the haemorrhage of cash through two disastrous private finance initiative schemes for hospitals in Queen Elizabeth Hospital, Woolwich, and Princess Royal Hospital, Orpington.

Having drawn up plans with the aid of a small army of costly management consultants, including McKinsey among others, Kershaw was required to publish his initial proposals for a 30-day public consultation, which ended in early December.

He then had a month from the consultation to formulate final proposals to go to the secretary of state, who then had a deadline to respond with a final judgement.

In other words, from mid-December onwards the procedure allowed no further public accountability, involvement or appeal. It is a fast track for cutbacks and closures.

This process has been even more outrageous because the trust special administrator, recognising that there was no solution to the financial woes of the trust within South London Healthcare itself, has broadened the swing of the scythe - to dump the greatest burden of cutbacks onto the neighbouring Lewisham Hospital, a separate, solvent trust delivering high-quality services.

Lewisham is one of the country's most deprived boroughs and its hospital delivers vital services.

But Kershaw's plan would close not only its A&E but also emergency surgery, complex surgery, emergency medicine, critical care and inpatient paediatric services - and almost certainly its obstetric unit too.

Lewisham would be reduced to an elective-only hospital handling non-complex cases, with a so-called "urgent care centre" tacked on.

As a result of these changes, even Kershaw estimates that 70 seriously ill emergency patients per day needing a bed would have to be taken to the Queen Elizabeth Hospital in Woolwich.

This means more than 25,000 extra seriously ill patients per year would arrive at a hospital that is already struggling to cope with emergency demand.

Queen Elizabeth's currently has no beds spare and no money to build any extra capacity.

Queen Mary's Hospital in Sidcup would lose its remaining inpatient elective services, and a "procurement exercise" would invite bids from various providers to run what would then be little more than a large clinic - "Bexley health campus" - with day surgery, endoscopies, a satellite radiotherapy unit run by Guy's & St Thomas's, and outpatients.

Sixty per cent of Lewisham Hospital, and the "surplus" buildings and land at Queen Mary's would be sold off, preventing any future expansion.

Queen Elizabeth Hospital Woolwich would be forcibly "merged" with Lewisham Healthcare Trust.

Princess Royal Hospital in Orpington could either - as Kershaw's preferred option - be "acquired" by King's College Hospital Foundation Trust, or its management might be offered up for "franchised contract" (ie a takeover) "similar to the approach taken for Hinchingbrooke Hospital in Cambridgeshire," despite the recent critical assessment of that arrangement by the National Audit Office.

On top of this, the trust special administrator is proposing more cuts in South London Healthcare, aiming to slash a massive 5.4 per cent of "cost improvements" from spending for three years.

One-hundred-and-forty doctors - one in six of its current medical workforce - and up to 400 staff nurses are to face the axe.

Scientific and technical staff are to be cut as well as cuts in the "non-clinical" pay bill.

In other words every single section of the South London Healthcare Trust workforce would be downsized, shaken up and saddled with additional workload for the next three years, while the trust itself would be broken up, its services reorganised, and Lewisham Hospital would be butchered.

The chaos does not stop there. The trust special administrator plans, apparently hatched up in just under three months, cover the whole of south-east London from now to 2017.

Some 618 of the existing 4,053 beds would close, although with 196 new ones the net loss would be 422 beds, over 10 per cent of the present total, on top of more than 500 beds closed since 2008.

Kershaw's plan does not come cheap. Dismantling Lewisham's services would cost £56m and other changes £68m - so with the £207m required to write off the accumulated South London Healthcare Trust deficit, the total is £331m of cash needed up front, plus an increasing £23m-plus annual subsidy to the PFI contracts into the 2030s. Around £750m all told.

It costs a fortune, but the viability of the plan drawn up by Kershaw hinges on the effectiveness of a new, expanded system of community-based care to replace care in hospitals.

But there's a snag - there are no concrete plans for any such services. It's all based on wishful thinking.

The trust special administrator also justifies the closure of Lewisham's A&E by claiming that 77 per cent of patients could still be handled through an "urgent care centre" or community-based services.

This claim has been demolished by angry consultants from Lewisham's emergency department, who are among over 90 consultants to have written hard-hitting letters pointing out major flaws in the plan Kershaw has hatched up with McKinsey.

Their expert estimate is that no more than 30 per cent of Lewisham's A&E patients could be safely treated in a free-standing urgent care centre.

This means well over 100,000 patients a year would be put at risk.

Lewisham Hospital currently admits 18,400 A&E patients a year as emergencies - this is equivalent to 41 per cent of the total A&E admissions for Queen Elizabeth Hospital Woolwich and Princess Royal University Hospital Bromley combined.

In other words, if Lewisham A&E is closed, the tidal wave of seriously ill patients, each needing immediate treatment and a bed, would completely swamp Queen Elizabeth's - almost doubling its workload.

Other specialist services, in many of which Lewisham is a major centre for training, would also be put at risk, including maternity, emergency surgery, children's services, critical care and emergency medicine. In exchange for losing local access to these services Lewisham residents get - nothing.

This devastation of a successful and busy hospital is the consequence of Kershaw's determination to preserve the contracts that are the root cause of the problems in south London - the two disastrous PFI schemes.

They have already added up to more than three times the combined cost of £214m, and are set to cost another £2 billion before they are paid off. The buildings alone are set to cost more than seven times the initial cost to build them.

The "unsustainable provider regime" has never been used before, but it's already clear that if this outrage is pressed home, between 20 and 60 more "failing" trusts across England will face a similar brutal onslaught, putting patients and health needs a poor second while in many cases bolstering profits of bankers and speculators coining it in from PFI.

Already Lewisham campaigners, recognising that they have everything at stake, have blazed a new trail to build the most vibrant campaign in recent years, with huge numbers supporting protests and meetings, and another massive show of strength set for today.

They may have to battle on well after Hunt's announcement on February 1, to challenge each cutback as it takes place. The consequences of inaction are too great to simply accept defeat.

But the campaign flags up wider issues too - Labour has talked of reversing Andrew Lansley's Health & Social Care Bill, but still, shamefully, defends PFI. That has to stop if more services are not to be sacrificed to keep PFI afloat.

Labour must also commit to scrap the dictatorial unsustainable providers regime, halt the £20bn funding cuts that are driving cutbacks and stop wasting billions on the costly, callous market system that has replaced planning health care to meet the needs of local communities.

Local MPs and Lewisham council have defended Lewisham hospital, while neighbouring Greenwich Council and Greenwich MP Nick Raynsford have done nothing.

It's high time to recognise that an injury to one is an injury to all, and an opposition to be worthy of the name has to unite to fight all these Tory cuts and defend the whole of our NHS - or sacrifice the support of their core voters.

• John Lister is director of Health Emergency.