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Is Hunt about to wield the axe on London hospitals?

Very interesting piece below posted from John Lister at Open Democracy:

Yet another attempt is being made to browbeat the wider public and the politicians who fear their anger into accepting wholesale closures of A&E and other hospital services to “save lives”.

Soon after NHS England’s shadowy “London Region” medical director Dr Andy Mitchell called for the closure of half of London’s surviving A&E units, an even more shadowy group of “senior doctors” from North West London have taken a similar stance, in a letter to Jeremy Hunt released to the Daily Telegraph.

Hunt is pondering the electoral implications of wielding his rubber stamp to endorse the death warrants on four A&E units in North West London. Closing these major hospitals’ A&Es would effectively reduce the busy Ealing and Charing Cross hospitals to small scale clinics.

Apparently nine consultants have now urged him to wield the axe.

They claim that closing these (and many other) A&Es would “save lives” by allowing patients to be treated in “fewer, larger hospitals”. Unfortunately that’s not what the present plans propose to do.

In fact the NHS North West London “Pre-Consultation Business Case” which sets the framework for the cutbacks makes clear that the plan would reduce bed numbers in most North West London hospitals by about 1,000 (25%). Inpatient capacity would effectively be wiped out in Ealing and in Charing Cross, and stand still or fall elsewhere.

Over 3.3 million people attended front-line A&E units in London in 2010-11 (rising to 3.6 million by last year). The A&E in Ealing alone handled over 90,000. Patients that will be diverted somewhere further afield, under these plans.

Around a quarter of patients attending London’s A&Es are admitted as emergencies. Average occupancy of London’s acute hospital beds is now over 90%. There is no slack. So closing an A&E to concentrate services requires much more than simply diverting individual patients: it means investing huge sums of capital in substantial expanded hospital capacity. But the money isn’t there – and neither are concrete plans.

So what’s the basis for these cutbacks? The quest for truly massive “efficiency savings” across the whole of the NHS in general and North West London in particular.

You can’t both save money on the scale required by the current government cash squeeze (due to tighten even further from 2015-2020) and build new capacity in hospitals. You save money by closing services, sacking staff and flogging off the sites – as they plan to do with Ealing and Charing Cross, and other hospitals elsewhere.

That’s why the 2,700 pages of the so-called “Decision Making Business Case” for the NW London cuts contains only a handful of pages even discussing the community-based and primary care services that are supposed to take the place of the axed hospitals, and none of these pages contains any concrete detail, commitment or timescale for action.

There is no plan for these services because there is no intention to provide them. The North West London plan is one for cuts, pure and simple. So for these senior doctors to be urging the process on suggests they are either cynical or terminally naïve.

Of course it’s all presented in a far more devious way, and there are a series of stock arguments that are always wheeled out. We are repeatedly told – in plan after plan – that the lion’s share of patients who attend A&E could be treated instead either in primary care or in “Urgent Care Centres”.

But the evidence shows, time and again, that hard-pressed GPs have neither the time, the energy or the resources to take over from hospitals – hence growing numbers of referrals to A&E from GPs. Claims that Urgent Care Centres could take on 50% or more of A&E patients are based on the experience of Centres that are attached to fully-functioning A&E units, not the free-standing units that are being proposed, miles and precious minutes away from a full A&E and hospital team.

Lewisham Hospital’s splendid Emergency Department consultants and staff banged this last point home firmly in their evidence-based response to the plans by the Trust Special Administrator to axe Lewisham’s A&E and other services. Hunt - and those determined to place cash balances above patient care - have chosen to ignore them.

It’s all about money. The case for closures may be argued by Medical Directors, and may make vague references to clinical issues, but the bottom line is that the frozen NHS budget, falling ever further behind rising demand and pressures on the NHS, is the key factor driving these cuts.

A handful of senior doctors, turning a deaf ear to concerns over the lack of transport links, longer emergency journeys and delays in treatment, may be banging the drum for the closures. But they are making no equivalent demand for clear, costed and timetabled plans to ensure that adequate care is provided anywhere else.

London Region Medical Director for NHS England Dr Andy Mitchell spells it out: he does not present a clinical case for cutbacks: it’s a financial argument, backed by the threat that if services are not cut back drastically London's NHS will build up a £4 billion deficit by 2020. He argues that the cash-strapped NHS “cannot afford” to provide safe staffing levels on wards.

Don’t forget what’s happening to the “savings” generated by these cuts: virtually none of them are being ploughed back into the NHS: instead over £3 billion since 2010 has been snatched back by the Treasury.

The cash squeeze comes from a political decision to hammer the public sector in general, and to do this by deliberately undermining public loyalty and confidence in the NHS in particular.

That’s why ministers delight in negative CQC reports and scandals of poor care. Recently the Foundation Trust Network’s Chief Executive Chris Hopson wrote in the Health Service Journal bizarrely celebrating the fact that an opinion poll had found fewer people (60%) supporting the view that “the NHS is a symbol of what is great about Britain and we must do everything we can to maintain it”. He seemed oddly encouraged that a growing minority (30%) have been bludgeoned by the right wing media into believing that “the NHS was a great project for its time but we probably can’t maintain it in its current form”.

They keep chipping away. But despite them the NHS is still much more popular than the politicians who are wrecking it, and whose long-term aim is to replace the progressive tax-funding of the NHS with a system of top-up insurance.

The cuts and reconfiguring of mental health services has gone further and faster than acute hospital care. So if fewer, bigger Trusts are really the answer on health care, why are mental health services now facing a desperate nation-wide shortage of front-line beds?

It’s time to say no, and force a rethink, before the same disaster befalls our acute hospitals too.

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