In a report commissioned by the British Medical Association, John Lister of London Health Emergency has done vital work in exposing the shady plans to dismantle London’s NHS. Lister paints a picture of the future of London’s health service that can only be described as catastrophic. The BMA is now mobilising its membership to build and get involved in campaigns with other healthworkers, patients and members of the community — to save the NHS.
It is a massive indictment of the trade union movement, and specifically the healthworkers’ union Unison, that the six-figure salaried medics have raised the alarm while other unions have done nothing. But what does the report say?
Over the next five years demand for healthcare is estimated to rise 4%. With current government promises that the NHS budget will increase only at the rate of inflation, this will leave a £15-20 billion funding deficit. The Tories are being vague but we can expect them to be more ruthless.
15% of the UK population live in London and the city is expected to take 20-25% of the cuts:
• At least 12 district hospitals are due to be closed.
• A third of hospital beds will close (a conservative estimate puts this at 5,600 beds).
• 21-37% reduction in nursing costs.
• 9-43% reduction in doctors costs.
• 25% reduction in drugs costs.
• 42% reduction in overheads.
• 32% increase in productivity.
• GP appointment times to be reduced by one third
The NHS bosses think that all this can be achieved by shifting 55% of outpatient appointments (around five million) and 66% of Accident and Emergency admissions (around two million) to “polysystems”.
A “polysystem” is the new name for a “polyclinic”. Presumably it is the same thing but without the bricks and mortar. The idea of polyclinics was first promoted in the Darzi Report in 2007. Under this scheme, the district general hospital is replaced by a three-tier system of “polyclinic”, “elective treatment centres” and “urgent treatment centres”. It is proposed that London should have 150 polyclinics which will have about 100 members of staff: about 20-30 GPs, 50-60 nurses and just 10 clerical staff ! They will deal with all the minor injuries and include other facilities like maternity wards.
At the moment, there are only a couple of polyclinics in London and they have not reduced demand on local A&E departments and the general district hospital. It is not at all clear why this system would necessarily save any money. A review by Pulse magazine claims that where the polyclinic system has been established it has been three-to-seven times more expensive than the current system. Moreover, there are massive clinical risks associated with fragmenting the service.
The whole plan rests on the notion that this system will somehow reduce demand. However, an Audit Commission report, More for Less published in November 2009, concluded that “Demand management is unlikely to make a significant contribution to any savings requirement in the short term.”
The proposal (which is lunacy from any kind of financial or clinical perspective) makes even less sense when we consider what is happening with PFI.
In Tower Hamlets for example, they have just built a new hospital through a PFI deal which will cost the taxpayer £5.3 billion for a £1 billion building. The hospital comprises 1000 beds, the building is yet to open but already Barts and the London Trust have announced that they will not be using 200 beds because they cannot afford the staff. Despite this, the taxpayer will still have to pay for the new beds at a cost of £1 billion over the next three decades.
Similar stories can be seen across the country where NHS services are being cut while the tax payers’ money is spent on obsolete building work.
Traditionally, the welfare state was a means of redistributing wealth from the richest to the poorest. Increasingly, with the bank-bailout and privatisation of public services, the valve is turned the other way. The state is increasingly playing the role of a massive slush fund, redirecting a portion of our wages, in the form of taxes, back into the pockets of the bosses. Alongside these structural privatisations, cuts will massively undermine the whole notion of free healthcare.
At a recent BMA public meeting, doctors and other healthworkers repeatedly emphasised that there was no political party that will save the NHS. Instead, we would need to build our own movement, using the kind of direct action tactics that saved the Elizabeth Garret Anderson Hospital in 1976-8. In the months to come, we must do all we can to build mass campaigns to save the NHS.
* NHS on the Brink
http://www.bma.org.uk/images/onthebrinkreport2010_tcm41-193388.pdf
