From the February issue of The Respect PaperLondon test-bed for NHS cutsJohn Lister, London Health Emergency
While all the main political parties vehemently insist that they are committed to safeguard NHS spending in the massive public sector cuts they are planning for after the election, it is clear that whoever wins the election in May will preside over the biggest NHS cuts in history.The largest cuts so far appear to be centred on England, where each of the ten Strategic Health Authorities has begun secret discussions on the scale of cuts required.
NHS London will shoulder the biggest reduction: working on the basis of a secret briefing document from management consultants McKinsey's, London's health bosses have estimated that the cuts in the capital will total £5.1 billion by 2017, equivalent to £673 for every man, woman and child in London.
And while most local Primary Care Trusts try to keep their plans under wraps, figures published for North East London give a stark warning of the scale and impact of the cuts that are being prepared for the days following May 6.
Plans to axe over 800 hospital beds across North East London, are contained in a devastating "business plan" published quietly just before Christmas: - effectively closing King George's Hospital in Ilford with the loss of 444 beds out of 496,
- closing 234 beds even before they open in the new £1 billion Bart's and London Trust,
- slashing 146 beds from Whipps Cross Hospital,
- and cutting Homerton Hospital by 76 beds (15%).
So massive would be the reduction in activity at King George's that its remaining acute services would require just one third of the space it currently occupies, with more than half the site to be mothballed or stripped of services and sold off: the plans include a £6 million allocation for redundancies of staff who could not be disposed of through "natural wastage".
Other plans include- More than a million outpatient appointments to be moved out of hospital clinics in NE London to primary care "settings" including polyclinics.
- Hospitals to face a 3% per year reduction in the "tariff" that determines how much they get paid for patient care.
- Sacking doctors, nurses and support staff. The consultation proposal looks to cut up to 37% from nursing costs, and up to 43% from spending on doctors.
- Hundreds of millions would also need to be saved by a combination of "Decommissioning services" (estimated savings £60m-£150m) and "Shifting acute activity to a lower cost setting" with (unexplained) savings ranging from £10m to £70m
- A range of primary care, mental health and community services would also be out to tender, with forecast "potential" savings of £200m to £550m "depending on how aggressive the commissioners chose to be".
To survive, NE London hospitals face a massive £500m savings target, the biggest target being a 35% saving on expenditure by the Barking Havering & Redbridge Trust (BHRT), while Bart's & the London is required to generate the largest amount in savings (£211m), equivalent to 32% of its current spending.
Savings on this scale will be even more difficult in BHRT and Bart's and the London, where hospitals have been built funded through the costly Private Finance Initiative (PFI) which locks Trusts into legally-binding, increasing payments for the next 35 years or more, imposing sky-high overhead costs.
Elsewhere in London, leaked documents and hints suggest that a third of the capital's 31 A&E units could be under threat.
North West London could also see up to six district general hospitals, including Ealing, West Middlesex and Central Middlesex downgraded to "local hospitals" leaving just three "major acute" hospitals in place.
In North Central London campaigners are already fighting plans to merge Islington's Whittington Hospital with Hampstead's Royal Free, with the probable loss of A&E services at the Whittington.
South West London, which is launching a joint campaign against the cutbacks, could be reduced to just ONE "major acute hospital" at St George's in Tooting, with the downgrading of Kingston, Mayday and St Helier to "local hospitals".
In SE London the axe is already hanging over Queen Mary's Hospital Sidcup, and Lewisham Hospital also seems vulnerable.
While the main health unions have been generally slow to respond, the BMA has effectively taken the lead, publishing a detailed report in January outlining the scale and impact of the financial cutbacks, and calling a public meeting for February 25, which has already attracted over 200 advance registrations.
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