NHS for Sale: Myths, Lies & Deception (15 page)

The campaign successfully pressurised one local Tory, Sir John Gorst, to break the whip of the struggling Major government, in order to press the campaign to keep the hospital open. He and a number of other Tory MPs subsequently lost their seats in 1997, while New Labour, having gained politically from the campaign, proceeded rapidly and shamelessly to close down the remaining services at Edgware that people had fought so hard to keep.

Soon after the 1997 election another local CHC was also right at the centre of a huge campaign, this time to defend Kidderminster Hospital, a fight which eventually cost the sitting Labour MP David Lock his seat after he backed its closure. Over 50,000 people marched through the small town of Kidderminster, and large numbers packed consultation meetings. The local Wyre Forest council joined with the CHC to challenge plans for the closure of 200 beds, A&E and most acute services at what had been a top performing hospital, and councillors from all parties voted unanimously to back a detailed document arguing the case against the closure.
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However all of this was simply ignored by the District Health Authority. They even confronted a judicial review, and went shamelessly into court where they found a judge who would uphold their right not to answer any of the vital questions raised by local elected bodies about the viability of services and finances if the closure went ahead. The DHA pressed ahead with their flawed plan for a new PFI Hospital in Worcester which, as campaigners had predicted, went badly wrong, with beds in seriously short supply, the promised efficiencies and shorter lengths of stay failing to materialise, and the extra costs of PFI pushing the trust into long-running
financial problems.

These were just a couple of the many fiercely independent CHCs which spoke up for local communities and patients up and down the country. It was these campaigners who incurred the wrath of ministers rather than the handful of deadbeat CHCs which allowed local NHS managers to call the shots.

The onslaught on the public voice has escalated in parallel with the creation of a competitive market in health care from 2001 onwards. Then, with the Labour Party still smarting from the recent loss of a sitting MP in Kidderminster in the 2001 election, Health Secretary Alan Milburn brought in proposals to scrap CHCs in England in the same legislation that established foundation trusts (in 2003) as part of the 2000 NHS Plan. Market style healthcare systems and reforms appear to be incompatible with even the relative modicum of local accountability and voice that prevailed at the time of the Kidderminster hospital campaign.

So CHCs were to be silenced, and replaced with the first of a confusing succession of toothless and largely neglected new bodies which few people ever heard of or understood (the most recent version of which is Healthwatch, established by the Health and Social Care Act).

It is no coincidence that the suppression of the public’s voice through CHCs came alongside the establishment of foundation trusts: one of their more frequently exercised ‘freedoms’ was that they were no longer required to meet in public or publish their board papers – or significant information on their performance and finances.
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Sadly an already tame news media was by then downsizing almost
every aspect of local reporting as newsroom staff were cut to boost short-term profits. The media became even more reluctant to carry any detailed coverage of changes taking place in the NHS, and local newspapers and broadcasters raised no complaint at the obstacles that would be erected to prevent journalists obtaining information on the day-to-day business and longer term plans of local trusts.

This erosion of local democracy was followed by the drive from 2005 to ‘transform community services’, which involved separating them from the Primary Care Trusts which in most cases were delivering these services, while also commissioning hospital and mental health care. Community services were to be separated either into free-standing NHS trusts, or floated off outside the NHS by becoming non-profit ‘social enterprises’. Labour went on to establish a ‘right to request’ in which any group of staff working in community health services could in theory request the opportunity to break away as a ‘social enterprise’ – although every single incidence of such requests was led not by frontline staff, but by the most senior management.
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In those community services that became social enterprises NHS trained staff would find themselves no longer NHS employees or covered by NHS terms and conditions beyond the limited protection of the TUPE regulations for staff transferred. The bodies would be outside the public sector, and run as businesses; the Freedom of Information Act would no longer apply.

Where these changes were implemented, they were carried through with little if any consultation with the local public – and often little or none even with the frontline
staff concerned. Among the social enterprises that were set up, some, far from empowering staff, chose instead to derecognise their trade unions. In East of England, a hotbed of privatisation and fragmentation, UNISON noted:

[S]ix of the 14 PCT provider arms in the six counties and two unitary authorities of Eastern England are seeking to remain within the NHS as Community Foundation Trusts, while the other eight look to wholly or partly non-NHS solutions.
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None of them proposed to consult the local public.

The Department of Health set up a whole unit to encourage and advise NHS managers on how to split off their services from the rest of the NHS and its management, and developed a deceptive rhetoric stressing the ‘power’ that would be given to frontline staff to ‘innovate’ and improve care for patients.
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This of course distracted attention from the fact that these non-profit social enterprises were businesses that would be forced eventually to compete with ruthless for-profit businesses in order to win the contracts they needed to keep them going. It would not be enough for a social enterprise just to break even each year. They had to deliver a surplus to allow any possibility of development: the pressures were hardly different from a private business. Moreover there was little reason why staff, whose views would have been completely ignored in setting up such social enterprises without their agreement, should have any confidence that the same domineering managers would take any note of them once the new business had been set up.

The further step of tendering contracts for various community health services to ‘any willing provider’ – encouraging
the for-profit sector as well as non-profits to slice off the services that seemed most lucrative and risk-free – also began in this same period, again generally with little or no public consultation. This policy was only halted briefly during the tenure of Andy Burnham (Health Secretary from the autumn of 2009 up to the 2010 election), who declared that the NHS should be the ‘preferred provider’.
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In 2007 NHS London commissioned Lord Darzi’s report on health care in the capital, which proposed sweeping changes to the structures of hospitals and primary care services, with the introduction of ‘polyclinics’ – a policy rejected by the BMA. This was followed by a farcical ‘consultation’ conducted by NHS London, in which just 3,700 ‘individuals and organisations’ responded (0.07 per cent) from a London electorate of 5.3 million – at a cost of £15m. The average cost per response of over £4,000 would have been enough to fly each respondent to the Bahamas for a focus group.

So the claimed ‘51 per cent majority’ for the Darzi proposals suggests a grand total of less than 1900 Londoners gave any mandate for the plan. (Even this is not clear. The ballot was conducted by Ipsos Mori, the consultants who had previously produced a contorted report on the public’s views of the proposed ‘Picture of Health’ reconfiguration of hospital services in south-east London. This completely sidestepped the evidence of the actual public voice by focusing not on the overwhelming rejection of the key proposals, but instead repeatedly highlighting the ‘interesting’ views of the tiny minorities that had registered some level of support).
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While still a Labour Minister Lord Darzi did however offer an important set of pledges, which if they were ever put into
practice would give the public a serious voice and a chance to influence changes. Trying to win back some credibility for the proposals, he offered five promises:

• ‘Change will always be to the benefit of patients.’
  
• ‘Change will be clinically driven.’
  
• ‘All change will be locally led.’
  
• ‘You will be involved.’
  
• ‘You will see the difference first. Existing services will not be withdrawn until new and better services are available to patients so they can see the difference.’
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The final one is potentially the most far-reaching pledge, since it committed NHS bosses to establishing new and improved services before existing services could be withdrawn and buildings closed. A pledge that no government up to now has been willing to carry out.

New Labour’s reorganisation of primary care trusts and strategic health authorities, merging them into larger, less accountable bodies, reduced further the impact of the public voice, but it did at least leave intact a framework of PCTs and SHAs as public bodies meeting in public and publishing the bulk of their board papers.

This was all swept away by the Health and Social Care Act. The CCGs it created are expected to meet in public, but occasionally take decisions behind closed doors. They are expected to publish board papers, but too often resort to claims of ‘commercial in confidence’ to withhold information on the increasing variety of tendering processes that they have been forced towards by the regulations governing the implementation of section 75 of the Act.

In 2009 the Unsustainable Provider Regime, giving draconian powers to a Trust Special Administrator (TSA), was introduced by Health Secretary Alan Johnson, and was ready and waiting for the Conservative-led coalition to use when they chose to override local opinion.
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In the summer of 2013 these powers were invoked for the first time, to address the crisis of the South London Healthcare Trust.
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The eventual proposals impacted most heavily on Lewisham Hospital. The lion’s share of cuts to fund a bail-out of the debt-ridden PFI contracts in South London Healthcare fell on Lewisham, a neighbouring but completely separate trust that was not in deficit or even serving the same catchment.

The hugely restricted ‘consultation process’ incorporated in the TSA timetable spectacularly failed to take any account of the overwhelming views of the local public, or of health professionals in the hospitals. Lewisham’s GPs, who came out clearly against the TSA plan, were also ignored, making a nonsense of claims that GPs were somehow in charge of the newly reorganised NHS.

Instead, the special powers were used to fast track a deeply flawed plan, offering no facility for proper scrutiny of the TSA’s actual proposals, which were then rubber-stamped by Jeremy Hunt with only minimal modification – more to the words than the substance of the plan. The plans to close and sell off two thirds of Lewisham Hospital were only eventually overturned through judicial review, which centred on a challenge to the powers of the TSA to act outside of the failing trust, not on the strength of the actual proposals themselves.
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There was no chance to force the decision-makers to recognise the fictitious figures and projections on which they were based, or the wider threat to the viability of local services and impact on health care in south-east London. And without a massive protest on the streets and in the wider community around the threatened hospital there would have been no judicial
review, and the flawed plan would have been implemented.

After even the TSA’s powers proved inadequate to press through the closure of Lewisham Hospital, Jeremy Hunt resorted to more legislation to weaken the public voice. The ‘hospital closure clause,’ section 119 of the HSC Act, gives carte blanche for a future TSA to ride roughshod over local communities where they find it politically expedient to do so. Like the HSC Act, this was carried through parliament with LibDem support.
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The perceived need for this clause is testimony to the failure of the proponents of reconfiguration schemes to win any significant public support for their plans. However, it is probably of limited value. For any government to begin repeatedly to invoke Clause 119 and the Unsustainable Provider Regime would be a desperate undertaking, amounting to an admission of widespread failure of hospitals under their watch.