It would be idiotic to suggest that both these cases were
‘just’ a matter of funding. Not all Trusts
– however cash-starved – have displayed the chronic lack of leadership which, the
Francis report argued was one of the critical problems in
Mid-Staffordshire. And there are real
issues about how to manage the competing demands of local accessibility, and the
development of specialist centres, in an NHS having to cope with an ageing
population – and this would be true however the NHS is managed. But in both instances funding issues are not
far from the surface.
The focus on A&E (and maternity services) in Lewisham
arose principally because of the financial difficulties experienced by the
neighbouring South London Healthcare Trust (SLHT). This organisation faced bankruptcy largely
because of the debts incurred through the previous government’s flirtation with
privatisation in the shape of the Private Finance Initiative. To rationalise health provision across South London , Jeremy Hunt was presented with a
recommendation to close both services.
In fact he rejected the recommendation, opting instead to downgrade
both, a compromise that still failed to meet local objections.
In Mid-Staffs, the appalling conditions experienced by large
numbers of elderly and vulnerable patients cannot be explained just by
financial problems. Nevertheless the
Francis report said that a chronic
shortage of staff, particularly nurses, was largely responsible for the
substandard care. As with SLHT, Staffordshire’s
problems derived partly from debts incurred because of its Trust status. In 2006/07
it was required to make a £10 million saving, which the Board decided could
only be achieved through cutting already insufficient staffing levels. And the
rest, sadly, is history.
Both sets of problems
predate the present government, and should be taken as warnings about the
dangers of introducing market principles to health care. But quite the reverse: Hunt (and Lansley
before him) have concluded that the way to deal with failing marketisation is
to introduce even more.
Despite all the promises (summed up in a key poster during
the election claiming ‘we’ll cut the deficit, not the NHS’) at the end of last
year the government was forced to concede
that in real terms spending on the NHS had been cut since 2010, despite
numerous statements from ministers to the contrary. Only two months earlier Hunt had assured the
Commons that "Real-terms spending
on the NHS has increased across the country." And the cuts are quite separate from the
government’s plan to make £20 billion of efficiency savings from the NHS by
2015.
The Lewisham case in
particular provides one example of how these ‘efficiency savings’ are to be
made. A national review of
casualty departments is underway, reviewing the prospects for the introduction
of a two-tier emergency service. And of
course Hunt’s compromise in Lewisham is for exactly that – by opting to
downgrade the Lewisham A&E, he took the first steps towards a two-tier
service. And it seems likely that the
SLHT will be divided up and offered out for full-scale privatisation.
The campaign in Lewisham may have succeeded so far; but given
the drive for more savings, the spread of privatisation, and the fall-out from
PFI debt, there is no guarantee that what’s left of any local A&E is safe
in the longer term.