A government-backed review of NHS services in London last week could lead to wholesale closures of accident and emergency wards, doctor’s surgeries and a number of district general hospitals.
The report by professor Sir Ara Darz, who is now an unelected health minister in Gordon Brown’s government, states that its aim is to reduce the vast health inequalities that exist within London and between London and the rest of the country.
Much of the media have concentrated on the proposals to develop specialist centres that would treat people suffering from particular acute problems, like strokes, or cancer.
Potentially this could improve the care of people who currently suffer because of the lack of trained staff, equipment and hospital beds.
However by proposing the development of over 100 “polycentres”, which would combine a number of GP surgeries with a host of other functions, the report opens up a new range of services to private providers, and could lead to a worsening of services for millions of Londoners.
Without a massive injection of resources into recruiting and training new staff it is unlikely that people who, for example, require long term heart or lung care, would receive the kind of attention that they would expect in a borough-based district general hospital (DGH), or at their local GP’s surgery.
They would be expected to travel to their nearest polyclinic on a regular basis in order to be seen.
Implicit in the report is the closure of many district general hospitals. The internal market within the NHS – introduced by the Tories, and upheld by New Labour – means that every hospital operates on the basis of payment by results.
Darz’s plan would see more work diverted away from DGHs, meaning that they get less money in their budget for the following year. Within a short space of time we can expect that many London DGHs will be said to be “financially unviable”.
When it comes to GPs, at present a GP in London looks after an average of 2,200 patients. It is likely that your doctor’s surgery is within a mile of your home.
Under the new plans, however, just four polycentres per London borough will replace many smaller surgeries – each will have between 60,000 and 80,000 patients on its books.
That means those who do not have a car, and for whom travelling distances is not an easy option, will find getting to see their GP a lot more difficult than it is now.
The government’s enthusiasm for the private sector means that it is likely that the new buildings will paid for using the Private Finance Initiative (PFI), or some similar method.
It is also possible that the polycentres will become private bodies working under contract to the NHS, in the same way that Independent Sector Treatment Centres (ISTCs) are now.
A number of private companies are already rubbing their hands at the prospect of getting a bigger slice of the NHS.
The Financial Times newspaper enthusiastically greeted the report, saying, “The change would herald a big reshaping of the current NHS estate, which includes 93 hospital sites, more than 1,400 mental health and community facilities and almost 1,600 GP practices that collectively are worth many tens of billions of pounds.”
Much of the report concentrates on attempting to move care from the hospital to the polycentre, or the home.
Anyone who has been forced to spend time in hospital recently would doubtless agree that home is generally a more comfortable place to be. However, the moves are being driven by the desire to save cash, rather than improve patients’ quality of care.
Community nurses and other practitioners report that they are already overwhelmed by the number of patients that they are expected to see during the working week. Many believe that their patients are suffering as a result.
In response to the report the campaign group London Health Emergency called for a referendum next May, as part of the Greater London Assembly and London mayoral vote.
They point out that the NHS London plans mean nearly a third of the city’s 32 major acute units would be closed or downgraded and London would be left with just three major trauma centres.
Geoff Martin of London Health Emergency said, “The proposed changes are so far reaching that they cannot be allowed to proceed without a democratic vote of Londoners and next May’s capital-wide elections are the ideal time to put this to the people.
“Changes like these should not be left in the hands of a bunch of bureaucrats sitting at computers at the Department of Health or NHS London.”
Closure threats to many accident and emergency units in London, and across the country, have given rise to large scale opposition. As thousands joined marches to defend their local hospital, the government were forced to draw up a “heat map” that indicated where such movements could lose Labour seats at subsequent elections.
Gordon Brown and the health secretary Alan Johnston have talked about a year-long review of the health service. The NHS London report shows the direction they want to take the NHS – cuts, closures and privatisation.