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August is normally a quiet month for NHS news but as the pace of the gathering crisis in the NHS hots up, August 2014 brought a whole host of issues into focus, illustrating the gathering crisis and the madness of the competitive market system created by the Tory Health and Social Care Act.
The big question is the burgeoning deficits in almost half the 140 trusts.
The Health Service Journal calculates that the deficits in 66 trusts add up to nigh on £1 billion and it will be little comfort to the bosses, staff and patients in the cash-strapped trusts to hear that in 68 other trusts, modest surpluses are expected, totalling just £167 million — and even these may be overoptimistic projections.
It’s these pressures, plus the growing chasm between frozen NHS budgets and the growing demand for healthcare from a growing population with an increasing proportion of pensioners, that is driving the motley but in essence fundamentally similar “reconfiguration” plans in localities up and down the country.
They all start from the same basic premise — a projected cash gap by 2018-19 that calls for urgent action and demands that “no change is not an option.”
They then offer fundamentally similar proposals to close or downgrade A&E departments, centralise specialist services and cut beds.
All of this is carefully obscured by a smokescreen of barely relevant waffle about improving public health, reducing smoking and obesity, delivering “care closer to home” and the need for greater “integration” of the NHS with the equally cash-strapped social care services run by local government.
Every one of these plans claims indignantly that it is “clinically led” and masquerades behind a happy-clappy and completely inappropriate title such as “Shaping a Healthier Future,” “Healthier Together” etc.
Many such plans are now at least partly in the public domain, although few have been accepted by the public, who quite rightly view with extreme suspicion anyone proposing to close trusted, accessible and popular local facilities and replace them with services “centralised” miles away, backed up by the vaguest promise of an undefined future alternative system which may or may not eventually be established “in the community” or “closer to home.”
Some plans are now coming to a head, and just beginning to face the anger of local people.
In west London, where this nonsense has been going on now for a couple of years, Imperial Healthcare Trust plans this month to close Hammersmith Hospital’s A&E service on the same day as the neighbouring Central Middlesex Hospital slams the door shut on its A&E.
The closures are being driven through despite the complete failure to implement grand promises of alternative services “in the community” or to expand bed numbers by the required amount in either St Mary’s Hospital — for Hammersmith — or Northwick Park, where an addition of 22 beds is well short of the peak levels of admissions at Central Middlesex.
Central Middlesex, the closest hospital to Wembley stadium, will be left with an “urgent care centre” that is run not by the NHS but by for-profit Care UK and, like all urgent care centres, it accepts only the most minor cases, with no beds. Patients requiring any serious treatment will need to travel elsewhere. Hammersmith patients will have a temporary choice of diverting to Charing Cross Hospital, until that too is axed.
Imperial plans to close and demolish Charing Cross, along with its top-performing stroke unit.
The majority of the site is to be sold off to developers, according to plans unveiled to horrified locals, plans which blatantly flout the findings of the Independent Reconfiguration Panel, which insisted that the full range of emergency services must remain at Charing Cross until genuine alternative services have been put in place.
In Lincolnshire, where health bosses plan to save £105m by 2018, one proposal which will give most concern is the idea of a single main A&E department to serve the whole sprawling county with notoriously lousy roads, in place of the current three A&E units (Lincoln, Grantham and Boston).
This solitary A&E would apparently be supported by a number of “A&E Locals/A&E care centres,” although the Lincolnshire Health and Care plan stresses that “an A&E Local does not have beds.”
Given this misleading language, it will be of little comfort to Boston residents to be assured that their local hospital has no plans to close its “A&E.”
Shropshire too is another rural county planning to reduce to just a single A&E, in Shrewsbury, leaving those with serious health needs in Telford to travel up to 20 miles for treatment.
In Bedfordshire and Milton Keynes, clinical commissioning groups are working together to develop cash-cutting proposals that seem set to downgrade Bedford Hospital, but which could also downgrade Milton Keynes.
The two hospitals are 19 miles apart — but for residents of either town to travel to another major hospital would be a journey of 23 miles or more.
An angry meeting in Bedford in early August indicates that the fight against this is now on, even before the selected options are revealed.
In Yorkshire the drive is on for cash savings through bed cuts and job losses in Calderdale and Huddersfield. Up the road in Dewsbury the picture is similar, where renal patients are being diverted as the first steps by Mid Yorkshire Hospitals Trust in downgrading Dewsbury Hospital to divert patients and revenue to help pay for the costly PFI hospitals in Wakefield and Pontefract.
In Birmingham the Heart of England Foundation Trust is being pressed to come clean on its plans, kept under wraps until now, for Good Hope and Solihull Hospitals, amid fears that patients will be diverted to the trust’s main Heartlands Hospital instead.
One reconfiguration that has become bogged down in confusion is that in Greater Manchester, where the usual incantations have been dressed up in the title Healthier Together.
But beneath the evasive rhetoric, the “pre-consultation business case” admits that the plan would axe 5,400 jobs over five years, three-quarters of them clinical staff.
There are many more plans, all with documents to deceive rather than enlighten those with the energy to wade through the soggy pages of disposable prose and inane graphics inserted as space-filler to deter all but the most committed.
But while NHS core services are under serious threat, the market madness is also developing at rapid pace.
At the height of the silly season came news that a private physiotherapy firm in Kent has just landed a plum NHS contract in Hull.
The desperately poor National Car Parks spin-off NSL, which is now England’s largest provider of non-emergency ambulance — patient transport — services, is deep in trouble up and down the country for its chronic failures to deliver the promised performance standards, with appalling delays in collecting patients from home or hospital.
At the end of July, a local scrutiny committee heard that West Kent clinical commissioning group felt it had the basis to terminate NSL’s contract, given a string of high-profile failures to collect vulnerable patients on time — including one patient left waiting for collection from hospital from 6.30pm to 3.30am.
But the clinical commissioning group would not do so for fear of a legal challenge from the company — and the lack of other providers able to take over the failing service.
West Kent is not alone in feeling powerless to act against poor-quality, failing private providers.
The Care Quality Commission has admitted that it was afraid to take strong action against below-standard care homes for fear of being sued by the private companies.
In Somerset, Musgrove Park Hospital Trust cancelled its contract with private firm Vanguard Health just days after dozens of patients suffered the consequences of substandard eye surgery in Vanguard’s mobile unit.
But the NHS will almost certainly wind up carrying the costs of compensation for the patients injured — and also faces legal questions over the severed contract.
But amid the chaos, some good news. Last week saw a fantastic 300-strong meeting in Stoke-on-Trent loudly reject the plans by four Staffordshire clinical commissioning groups to hand over control of the £1.2bn budget for cancer care and end-of-life care to one or more private companies — making this, by my reckoning, the biggest-ever public meeting against possible privatisation.
Some 10,000 have signed the petition — and thousands are now waiting for the shortlist for the contract, to be announced this month. This will run and run.
The unions are balloting for action on NHS pay which has been shamefully cut in real terms.
And of course the courageous 300-mile protest of the Darlomums on the People’s March for the NHS has been taking the fight against cuts, closures and privatisation to towns and cities down the eastern side of England.
It concludes in London today with what should be a massive reception.
They have managed to unite a wide range of support — and set the tone for the next seven months campaigning to defend our NHS by removing the Tories and their hangers-on, and demanding more money for the NHS and an end to privatisation.
Anyone who can should join them in London for the rally at Trafalgar Square at 3.30pm. See you there.
John Lister is director of Health Emergency
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