Special Spring Bulletin n April 2010 n

Whoever wins
on May 6 – fightevery cutback!

Gordon Brown has fired thestarting gun for the race that
was already in full flow, and in
4 weeks we will know who has
won the 2010 General Election.
Many angry activists, frustrated at New Labour’s adherence to Thatcher’s anti-union
laws and continuation of her
privatisation offensive haveargued that there is “no choice”
between the main parties: but
one area this is clearly not trueis the NHS.
While 18 years of Tory rulesaw the NHS face cuts, the privatisation of hospital support
services, Thatcher’s mad, costly
and wasteful “internal market”
reforms, more cuts, and soaring waiting lists 13 years ofLabour rule has brought a realtransformation.
Huge new resources havebeen pumped in to the NHS:
spending has risen at the fastest rate in 60 years, with thehealth budget almost trebled
since 1997 with generous
above inflation year on year
increases since 2001, and theshare of national wealth spenton health has increased towards the European average.
Waiting times are down, andwith the 18-week maximum
wait are now among the bestin Europe: staff numbers are up– even if far too many of theseare managers.
There are new hospitals, too– although almost all of thesehave been funded through thecontroversial Private FinanceInitiative, the most expensive
and riduculous possible way
to secure the money. PFI is justone of many weaknesses inLabour’s record, of which weare all aware.
Another fundamental problem is that instead of sticking
to their promise to sweep
away Thatcher’s costly andwasteful market system, Blair(and now Brown) have hungon to it, made it more complex
and bureaucratic, and broughtin far more private sector involvement than the Tories ever
dreamed of. Overhead costs
have mushroomed, while thetalk of “efficiency” has neverbeen louder.
With the market has cometoday’s indecipherable jargon
of “World Class Commissioning”, the swarming of private
sector management consultants; the relentless drive todraw in private providers todeliver clinical services andeven community and mental
health services through the“Transforming Community
Services” policy; the position-

ing of Richard Branson’s Virgingroup and Care UK to exploit
the current fad for expensive
new “polyclinics” and privatisation of primary care; the expensive irrelevance of “Independent Sector Treatment Centres”;
the “patient’s choice” initiative
encouraging NHS patients toseek simple elective treatmentin private hospitals, leaving
their local NHS hospitals facing
financial losses: and of course
the costly folly of the billions
squandered on a complex computer system that still doesn’t
work … and much more.
But while Labour could obviously have spent much of theextra money more wisely, andeven now could save billions
painlessly by changing course
on some of these policies, weknow from their previous 18
years in office that the Tories
wouldn’t have spent the extra
money at all.
Left to them, the waiting
list would still be with us, withhundreds of thousands of people still waiting 18 months ormore for treatment in crum-bling and poorly-cleaned
hospitals. And while Labour
has stupidly rolled out the red
carpet for private providers,the Tories would be even moreeager to please any of their big
business friends who fancy aslice of the NHS budget.
So let’s use the election
period to keep the pressure
on the main parties to halt the£20 billion of cuts in the next
few years, which threaten todevastate many local services,close hospitals, axe tens of
thousands of beds and NHSjobs, and throw more qualified
staff on the dole queue.
Both parties threaten that,and these cuts must be fought,
no matter what the result of
the election. But let’s not forget that in 62 years of the NHS
only one ruling party has had
the courage to pump muchneeded resources into healthcare and create a service thatgives us so much to defend.
Ignore that difference
and we could have years toregret a Cameron government.

Cuts keep coming … witheven more to come after May 7
l Leicestershire Hospitals £58m and 700
jobs to go in 12 months
l Southampton Hospitals £100m cut and1,400 jobs to go in 4 years
l Salford Royal Hospital 750 jobs to go in 3
years, budget cut by 15%l Oxfordshire Hospitals: £45m cut in 12
monthsl Cambridge University Hospitals £35-£40m
to cut over 3 years, all sections of staff urged
to consider taking redundancyl Gloucestershire Hospitals £27-£30m cuts,
200 beds
l Nottingham University Hospitals £28.8m
cuts over 12 months
l Gateshead Hospitals 100 beds face closurel Arrowe Park Hospital, Wirral: £13m cuts
per year for 3 years

Best chance yet
to stop NHS cutspredict – the election leaves a
In the run-up to the election,
hung parliament or a very narcampaigners fighting therow majority for the winners,
closure of A&E (and almost
raising the prospect of anotherall inpatient services) at King
election soon afterwards.
George’s Hospital, Ilford, won
The cuts themselves are
an important concession.
politically unpopular as soon
Health Minister Mike O’Brien,as they are revealed:visiting the tightly-baland with £20 billion
anced constituency, Ilford
r
e
d
r
o
to cut in England,announced that the Recthey are on a scaleclosure would be rethat the general
ferred to the “Recons
ltMinister ha npublic can underfiguration Panel”.
lastand would put
This may not lead A&E axe p
their services at risk.
immediately to reWe can be certain
versing the closure,that a shaky govbut it gives campaignernment will not
ers more time to pile
want to alienate more supon the pressure. It
port by pushing through big
gives a flavour of what may
cuts and closures in the teeth of
be possible for camwidespread opposition.
paigners
No local MP would relish theif – asnotion of becoming the next
someDavid Lock – the deservedly
forgotten Blairite junior minister, who lost his safe Labourseat in Wyre Forest to an Independent in 2001, after foolishlyendorsing the closure of his
local Kidderminster Hospital.
But to put this type of pressure on, health workers andtheir unions need to build
strong and broad campaigns
reaching deep into local communities. Make no mistake: if
there is no mass pressure, arrogant health bosses will pushthrough whatever crazy plans
they like.
It’s up to you: everywhere
hospital services are seen to bethreatened, local communities
have shown themselves readyto fight back.
In 2006 this type of campaigning rolled back many of
the cuts being driven by Patricia Hewitt. This time, with theunions fighting also in defenceof jobs and working conditions, the campaigns can beharder and stronger.
If you don’t fight, you can’t
win. And then we all lose.
.co.ukdrecorder
www.ilfor
on your mobile- and now.uk
corder.com.ilfordre, MARCHTHURSDAYNo. 5788

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INSIDE THISWEEK

Cartoon taunts
outrage Tories
page 2matriarch
Pop family
diespage 4death
Vandals targetlake
page 6into
Eyesore turned
new home
stunning
page 7spending
Unhealthytrust
loses our 10
page
Letters
victimSex attack silence
breaks her: Ilford North
DELIGHT
healthMP Lee Scott,Mike O’Brien,
ministerMargaret
Barking MP Ilford SouthKing
Hodge andGapes at
MP MikeGeorge Hospital(Wed)yesterday

page 15
US, FULLHOW TO CONTACT AND
LIST OF CONTENTS
PAGE 2
WEATHER:URE govhave
UNDER -PRESS
chiefsplans
ernmen t
brakes on
slammed the George Hospito axe King
(Weds)
tal’s A&E.
yesterday

Cheers erupted in Barley Lane,forhospitaloutside the s, as Minister of State
Goodmaye
Mike O’Brien
referring the
Health Services
he would beannounced to an independent reconproposals panel for review. plans –figuration the controversial mater-

this is to
how important
It means have seen A&E and George
we said about
lives
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are not protected,
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But amid the review does notchief executive
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tocerns that maternity, is enormously
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A&E and area.
decision Mr O’Brien, plans.
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AN DRIVER’SWN IN WOM‘ACID’ THRO

FACE: p3

Contact LHE: email healthemergency@googlemail.com. l See our website www.healthemergency.org.uk

“Efficiency savings” that are not efficient and save nothing

Phony figures andquack policies

Strategic Health Authorities are
insisting that 60% or more ofpatients attending A&E could
be properly treated b y GPs
and primary care nurses: but arecent Department of Healthcommissioned study whichchecked on actual people inreal A&E departments foundthat as few as 10% and a maximum of 30% of patients there
did not require hospital treatment.
SHAs and PCTs are also try-

ing to shunt millions of outpatient appointments into “polyclinics” – few of which so far
exist even on paper, and noneof which are operating on alevel large enough to deal withthis caseload. They could be avery costly failure.
A 2010 report by the National Primary Care Researchand Development Centre,
which checked 119 studies onshifting services to primarycare has warned that:“Savings in cost were offset
by increases in overall service
volume and loss of economies
of scale. … There is a risk thatthe quality of care may decline
and costs may increase”.
Health chiefs seeking toswitch mental health into
polyclinics are also defying
evidence in the latest researchfrom the same organisation,
which warns that
“Polyclinics provide newopportunities: but with thosepossibilities come potential
threats and risks. Of key importance is the threat that they
will re-institutionalise mental
healthcare after many years ofbreaking down these barriers.”
The evidence is equally thinto support other stock plans:l Polyclinics are likely tocost far more than existingmodels of primary care. Darzistyle health centres are costing
3-7 times more than conventional health centres.
l Axing tens of thousands of hospital beds without
proven alternatives in place is ahuge gamble.

Civil service union leader Mark Serwotka has been arguing forsome time that the government does not even need to increase
taxes to bridge the gap in public sector finances: they just need tocollect the taxes that are owed but not paid.
The PCS estimates the “tax gap” at £120 billion, but the government (with all party backing) is cutting the numbers of tax collectors employed by HMRC, each of whom generates a net profit of£600,000 a year for the Treasury, and closing tax offices.
ther round of cuts would thenhave to follow.
Lurking in the backgroundis the grim example of Mid
Staffordshire hospitals, where
the quest for just £10m of cuts
resulted in the loss of 150 clinical posts and a total collapse incare, with dozens of hundreds
losing their lives as a result.
Managers who fail to learn
from existing evidence could
be doomed to repeat this typeof failure.

l Glib talk of “productivity
increases” of up to 35% (nurses)
and 43% (doctors) over the
next five years and cutting theworkforce by not filling vacancies avoids any discussion of
the consequences for patientcare and for the staff remaining.
If these plans misfire, the
NHS loses out both ways: services can be undermined andpatients put at risk. And if theassumed cash savings do notmaterialise, an even bigger fur-Want savings? Cut here!
please. They are everywhere – costing
the NHS £500m or more a year – anddeliver pitiful value for money. The
Health Secretary should sack the lot,
and tell NHS managers to get on withthe job they are already handsomely
paid for: managing services.
The third recommendation centres on
unpicking some of the more expensive
bureaucratic experiments, beginningwith scrapping the fraudulent WorldClass Commissioning programme – andswitching any capable staff involved
to useful work elsewhere.
The Competition Panel, and all of
its regional spin-offs, and the nationaland regional-level Commercial Directorates should also be ditched as a costly
diversion that could potentially do massive structural damage to the NHS.
Other pointless bodies created tohelp create a market system instead of ahealth service also need to face the axe,
beginning with the little-known but

Affiliate to Health Emergency for 2010!

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1 
INSIDE

Spring Bulletin  April 2009  FREE

Scandal of Mid Staffordshire proves the case …

 World Class
Commissioning The unfair
Competitionpanel Sneak attack
on PCT staff

SE London: from‘super-trust’to
super cuts

The ministerial rubber stamp hascome down, finalising plans tomerge “local” hospital services
in Outer South East London intoa single, cash-strapped Trust –without even the pretence of apublic consultation.
The new so-called “super
Trust,” covering 800,000 residents
in Bexley, Bromley and Greenwich, and straddling a massive
swathe of SE London from theMillennium Dome to the M25,
will launch with historic debts of
up to £200m.
Bromley’s Princess Royal University Hospital Trust alone has
racked up a staggering £110m
deficit, fuelled by a PFI hospital
contract.
Queen Elizabeth Hospital
Trust now admits its PFI hospitalis ‘underfunded’ to the tune of£8-£10m a year: it has debts of£65m and projecting anothershortfall this year of almost £6m.
Bexley’s Queen Mary’s Hospital, Sidcup, is universally seen as
the “soft target” for cuts in services as soon as the new merged
Trust starts in earnest to balanceits books.
Local health chiefs deliberated avoided any public consultation on the merger process.
after failing to win any significant public support at all for theirplans back in 2007.

  

984 2009  
  
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      
Commissioners
and “regulators”
      
   quality
care     cannot ensure       
 
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
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


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
 
   
  
        
   
     
 
   

 
 

    
   
 
       
 
 
        

 

  
   

 

    
  

  
 
 
 
  
      
  

    


  

  
   
  
            
   
 
     
           
 
  
         
 
       


 

 
   
   
 
    
    

 
 
   

  

 
 
 
 
 
  
 
      
 
         

  


 
  
   

 
  



     
  
  
  
  


 


 

 
    
       
  
  
 
 
 
     
             

 
 
 


                     
 
    

     
   
  

   
  

 

     

    

 

  

     
     
  
 
           

 
  

     
 
       


     
   

 
  
 

 

 

   
     

  
     
  


 

 

 
      
      
      
 
  

  
  
              
     





CONDITION CRITICAL
      
 
     
   

    
 
    
              
  
   
              
 
 
 
             
          
 
    

 
                    
  
           
    
 
          
   
     
                 
 
 
 
              

 
 
     
        
   
     
          
 
  
    
        
 
 

    
             
 
  
      
                         
  
  
  
 
         

           
  
 
                
                          
  
          






    
 

      
          
  
 
 

                     
 

   
 
      

  
 
      
   
 
 
                
     
 
 
 

The disastrous and dangerous poor performance uncovered at Mid Staffordshire
Hospitals Trust a few weeks
ago was more than a one-off
local management failure. It
was a dramatic systems failure
demonstrating that no level ofthe new “health care market” isable to ensure quality care forpatients.
Key culprits were the local
management, who slashedstaffing levels of nursing andmedical staff to half the minimum to cut costs as they pursued their bid for Foundation
Trust status. But where were
the protests from the professional bodies which are supposed to uphold basic standards of care?
Also remiss was the local
Primary Care Trust, “commissioning” services on the basisof the budget, without any
scrutiny of the quality of patient care. Of course the traditional patient watchdog, theCommunity Health Councils
were long ago scrapped byministers wanting a quiet life:
not a cheep was heard fromthe toothless bodies that havebeen put in their place – thePatient Advocacy Liaison Service, the Patient and Public Involvement Forum or the local
council Scrutiny Committee.
Nor were the over-paid, under-worked bureaucrats of theWest Midlands Strategic Health
Authority on the case: they
apparently only find out about
quality of care when alerted by

the Healthcare Commission.
Their boss at the time, Cynthia
Bower, having failed to spot
this major failure in the middleof her patch, is now stepping
across, ludicrously to head theCare Quality Commission.
NHS boss David Nicholson
also held senior management
positions in West Midlands
SHA up to 2006: small wonder
he and Bower are so determined to squash calls for any
independent inquiry into what
took place and why.
Meanwhile Monitor, theFoundation Trust regulator has
been exposed as focused narrowly on the balance sheets
and business prospects of those
applying, rather than paying any
  
  
     

   
   

 

    
 
 
 

     
  
   
    
      
 

attention to patient care.
All this goes to show that
“regulation” as a means to ensure quality and accountability
is as inappropriate in a healthcare market place as it has beenshown to be in banking, finance and the wider economy.
Ministers are even now
splitting the NHS into fewer,
less accountable providers,each seeking to deliver a surplus at all costs; but a serious
response to the Mid Staffordshire crisis would be to slamthe brakes on this, before morepatients die from avoidable
sub-standard care, and before
the notion of health care as a‘business’ completely rots thefoundations of our NHS.

Contact LHE: email john.lister@virgin.net

An International Conference on the marketisation of healthcare and the role of the media
Saturday June 20 10.00 - 3.30 (lunch provided)
Coventry University

Called by the International Association of Health Policy in Europe, supported by Coventry
University, People’s Health Movement, the International Journal of Health Services, the Politics ofHealth Group, the NHS Consultants Association, Keep Our NHS Public and Health Emergency.

Join a discussion with speakers and campaigners from Europe, Africa, the US andCanada on the common threats and issues – and the fight to defend health as apublic service.
Free entry for health unions and campaigners, but prior registration required: contact
j.lister@coventry.ac.uk

  
     
      
 
    
 
  

John Lister



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affiliated (since November 2009,)
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

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dangerously ill-conceived ‘NHS Primary
Care Contracting’.
There should be a full value for money audit of all senior management anddirectors’ positions through the Strategic Health Authorities, Trusts and PCTs.
Health unions and professional bodies
should help scrutinise the claims of what
has been achieved – leading to a cull ofbosses who add nothing to patient care.
And there must be no more highcost contracts and preferential deals
with private sector providers: Independent Sector Treatment Centre contracts
must be scrapped, bringing the work
contracted out at higher costs back inhouse to restore the viability of flagging
NHS units as well as medical training
and research.
This popular package of cuts could
painlessly save huge sums of money –and liberate many managers and staff
to do productive instead of pointlesswork.

183 mm

A few simple steps could be taken thatwould cut the health bill by a billion ormore each year.
Trust payments to Private FinanceInitiative consortia are set to hit £1.3
billion in 2011, and rise year by year,
despite warnings that NHS budgets willat best be frozen in real terms.
A report on the notorious PFI
scheme at the Norfolk & Norwich Hospital, which yielded massive windfall profits for shareholders, showed that there
could be huge savings even now frombuying out the PFI deal.
Many of the PFI hospitals alreadyup and running have been financed bybanks we (the taxpayer) already own:
so why not scale down or scrap thehefty unitary charge payments on these
deals, and seek ways of buying out any
schemes financed by other banks, especially now the Bank of England baserate of interest is at a record low 0.5%?
Or take management consultants – 
  Faced with a staggering £20
billion gap between a frozen
NHS budget and the likely
demands and costs on healthservices by 2017, managers
have responded with panic
measures to slash back capacity. But of course they can’t
admit that these are “cuts”,
so they harp on misleadingly
about the need for “efficiency
savings” and “reconfiguring
pathways” – and a host of otherjargon phrases.
But what is the evidence
that the new proposals to divert tens of millions of patientsfrom A&E and from hospital
outpatients to primary careand “lower cost settings” canactually work, or save any
money?
There is none.
There is no experience inthis country or anywhere elseof shifting patient care on thislevel out of hospitals: indeed
a recent Audit Commission
report pointed out that as recently as last year, despite wellover a decade of rhetoric on
the need for these changes,
there had been“no shift from hospitals
to care closer to home in thecommunity, either in terms ofinvestment or activity”.
Nor have PCTs had any serious success in “demand management” reducing the use of
hospital care: instead the numbers of patients referred by
GPs to hospitals for inpatientcare has continued to increase,leaving most hospitals “overperforming” on their contracts.
Now the NHS has triedpress-gang Trusts into slamming the hospital doors in thefaces of these excess patientsby refusing from this year to
pay the full cost of additional
patients above the planned total. Trusts will receive just 30%of the tariff cost of treating any
patients in excess of the 2008-9
caseload. What are Trusts supposed to do when the patientsarrive seeking treatment?
There is no answer.
Plans to remodel services
are based on false assumptions. NHS London and other130 mmContact LHE: give John Lister a call on 07774 264112, or email healthemergency@googlemail.com