Massive cuts to emergency health care in northwest London

By Richard Duckworth and Paul Stuart

8 November 2012

Massive cuts to emergency health care are going ahead in north west London. Four out of nine accident and emergency (A&E) departments catering to nearly 2 million people face closure, part of £20 billion worth of cuts to the £108 billion National Health Service (NHS) budget nationally demanded by the Conservative-Liberal Democrat coalition government. Current plans indicate that eight of London’s 32 A&Es will close, as will a further 18 across the UK.

The four A&Es slated for closure in northwest London are Charing Cross Hospital, Ealing Hospital, Hammersmith Hospital and Central Middlesex Hospital, which will be downgraded to “Local Hospital” and “Urgent Care Centre” status.

NHS North West London (NHS NWL) management have made clear they intend pressing ahead with the closure programme in 2013-2016 as part of £1.2 billion cuts to the NHS budget in London.

The closures are part of the cynically named “Shaping a Healthier Future” (SAHF) program initiated by NHS NWL at the end of 2011 in collaboration with McKinsey & Company, corporate management consultants to some of the biggest private health care concerns in the world. The program targets cuts of £314 million from hospital budgets and £297 million from its commissioning budget, threatening up to 5,600 job losses by 2015. NHS NWL trust has refused all pleas to extend a so-called “consultation” period and conducted an expensive media campaign against its critics.

The fate of the A&E department at Ealing Hospital sums up the criminal character of the closures. The hospital will be reduced to an Urgent Care Centre and legally blocked from treating an array of life-threatening injuries. Nine out of eleven major services are likely to be removed. At a public meeting earlier this year, a large number of doctors protesting the closures explained how the remaining A&E units would not be able to absorb the workload if the closure goes ahead. One of those units, at Northwick Park hospital, already closes its doors one out of every ten days to emergency cases and is forced to send patients to Charing Cross, one of the other units slated for closure.

The closure of A&E units will lead to a massive increase in the need for ambulances to transfer patients, threatening the priority for 90 percent of emergency cases to get to hospital within the “golden hour”. The London Ambulance service is facing cuts of £53 million and the loss of 560 jobs by 2015.

The creation of Urgent Care Centres and Local Hospitals and the withdrawal of a significant range of emergency care units as well as specialist staff and facilities are the first phase in opening them up to private tender under the auspices of the 2012 Health and Social Care Act.

To obscure the fact that this assault is being driven by politicians from all the main parties with extensive ties to private health companies, in alliance with highly paid management consultant companies, NHS NWL spokespersons claim that it is “led” by clinicians who would never dream of recommending proposals that jeopardise patient care. Although a number of senior clinicians are fronting these measures, the vast majority have opposed the closure programme in a series of letters, protest meetings and marches.

In October, a 50,000-signature petition was handed into NHS NWL headquarters by the Save Our Hospitals campaign—led by the Labour Party, the health trade unions and the pseudo-left Socialist Workers Party (SWP). Its chair is Labour MP for Hammersmith Andy Slaughter and Labour-led Ealing borough council alone has ploughed £45,000 into the campaign. It is nothing more than a propaganda exercise, assisted by the SWP, to restore Labour’s shattered authority and to wipe from memory the last Labour government’s responsibility for laying the groundwork for the present assault on the NHS.

The last Labour government enforced the 2004 Agenda for Change that has laid the basis for the imposition of regional pay, vastly expanded Private Finance Initiative (PFI) hospitals whose repayments to private contractors have financially crippled many NHS Trusts, laid the groundwork for the Health and Social Care Bill and opened up the NHS to a vast array of private health companies.

On October 5, London Borough of Ealing (LBE) Labour council, which is imposing massive cuts to local social services, held an extraordinary meeting to discuss its response to the A&E consultation procedure due to end a few days later. They formulated their submission by paying £55,000 to consultancy firm Tim Rideout Ltd. to produce a report. The council declared it did not support the NHS NWL proposals in their “current form” because there were “flaws” in its “business case”. However, it sympathised with NHS NWL because, as Rideout reported, “LBE faces exactly the same challenges in relation to its own services and statutory rights.” The council accepted “that ‘No change’ is not a feasible way forward” and offered its services in “identifying alternative ways” to cut services.

Latest reports indicate that the total number of A&Es facing the axe has now risen to 32. Frenchay hospital in Bristol has just announced the closure of A&Es and in Maidstone, Kent, emergency cases are now being sent on a 14-mile half hour journey to Tunbridge Wells. A similar fate awaits the major trauma cases in Cheltenham, which will have to be taken to Bristol or Gloucester. In East Sussex either Eastbourne General Hospital or Hastings Conquest Hospital in Hastings will be closed, meaning an additional 21 miles along mainly minor roads for treatment.

Last February an NHS commissioned report by McKinsey & Company said London had “too many acute hospitals.” It said that only 6 out of 18 non-foundation NHS Trusts would be financially viable by 2014-2015 and a small increase in inflation would increase this to 16 out of 18 acute hospitals

Health Secretary Jeremy Hunt is set to rubber-stamp proposals to the shut the casualty unit at one of those hospitals targeted in the McKinsey report—Lewisham Hospital in southeast London. South London Healthcare NHS Trust is on the verge of bankruptcy. It runs three hospitals, Queen Mary’s in Sidcup, Princess Royal in Bromley and Queen Elizabeth in Greenwich, serving a population of one million. It is the first NHS body to be taken over by Whitehall-appointed administrators and is now run by Matthew Kershaw, the Department of Health’s £150,000 a year director of provider delivery. One of Kershaw’s first proposals was to dissolve the Trust and close Lewisham Hospital A&E six months after it reopened as part of a £12 million refit.

Kershaw’s review was prepared by private consultants, who also suggested that the 525-bed Princess Royal, built in 2003 and funded by the sale of the land occupied by Bromley Hospital and money raised through the Private Finance Initiative (PFI), be offered to a private company. Hovering to pounce are companies such as Circle (which runs the UK’s first privatised hospital in Hinchingbrooke in Cambridgeshire), Serco and Virgin. Kershaw outlined that the deficit in South London will be £65 million this year but a third of this is made up of PFI payments, many from schemes carried out under the last Labour government.