January 23, 2013 by Protect Our NHS
Last year, the government launched its NHS “failure regime” for the first time, due to the intractable indebtedness of south London Healthcare NHS trust. With many other NHS trusts in financial difficulty, the process has worrying implications for the NHS in England.
The trust special administrator’s proposed solution involves the effective gutting of a neighbouring hospital – the high performing and financially solvent Lewisham hospital.
Under the proposals, its assets would be sold and income streams diverted to bail out the struggling Queen Elizabeth and Princess Royal hospitals. Lewisham would lose full emergency services and would become an elective centre for south-east London – requiring costly rebuilding, and with no existing model on which to predict success.
In addition, the hospital’s full maternity services would be replaced with a midwifery led unit, again a dubious model in inner city London where the majority of women will be diverted to units that are already busy and will have to be enlarged.
It is claimed this will result in better quality care and sustainable providers for south-east London.
There is no evidence for this and it is not supported by local commissioners – one of the key four tests the trust special administrator (TSA) is required to meet. Even the TSA agrees that Lewisham is a high performing organisation.
As the clinical commissioning group (CCG) chair for Lewisham, I sat on the TSA’s clinical advisory group. The group was barred from considering existing quality as it was assumed any new organisation would automatically meet quality standards. The only arguments permitted were financial.
We were told that five A&Es in south-east London were not affordable, so the number must be reduced to four in future. We were not allowed to question this assumption, and Lewisham – without protected foundation trust status, not linked to long-term PFI debts, and with releasable assets – was the TSA’s obvious target. This was justified by the TSA’s claim that future finances for Lewisham were precarious.
No matter that these figures were disputed by both Lewisham’s CCG and by Lewisham Healthcare NHS trust, and in any case were trivial amounts compared with the debts existing in south London Healthcare NHS trust.
The lessons of Mid Staffordshire, where finances took precedence over quality, are relevant here. Lewisham’s exemplary paediatric services would be lost under reconfiguration, and there is little likelihood their replacement will serve local children half as well.
Lewisham’s maternity services deliver 70% of local babies, so dispersing these to other, already over-stretched units almost guarantees reduction in patient experience and risks poorer outcomes in large, busy units.
Local commissioners have said unanimously this is unacceptable. The local authority has condemned the proposals as harmful to local health and damaging to local finances and the rushed health equality assessment has cited major concerns regarding the proposals.
Despite this, the need for financial balance and perceived requirement for rationalisation has overruled all cogent argument. If approved, this will set us on a risk-ridden course towards poorer services.
Ironically, the proposals do not even make financial sense, as the TSA plans to spend £195m to get £19.5m savings a year.
There is a clear alternative, which is to let GP commissioners do the job they are meant to do, and work with the local healthcare experts and patients to plan the future.
Dr Helen Tattersfield is chair of Lewisham clinical commissioning group and a GP