Yesterday the People’s Enquiry into NHS London published its report. This summary of the report, London’s NHS at the crossroads, is republished from the Open Democracy website under a Creative Commons Attribution-NonCommercial 3.0 licence. It is very useful for the campaign to save Calderdale and Huddersfield A&E and NHS – particularly in demanding a duty of candour for NHS managers and ending cash-driven closures.
London’s NHS at the crossroads
John Lister 21 March 2014
A duty of candour for NHS managers and ending cash-driven closures – those are amongst the recommendations of the People’s Inquiry into London’s NHS which raises serious concerns of creaking services in the capital.
Cash-driven hospital ‘reconfigurations’ – so hotly contested across the capital – must
stop, say a panel of experts conducting a ‘health check’ into London’s NHS. Instead they
call for a London-wide needs assessment to match services to patterns of need across the capital.
The panel also calls for NHS managers to be placed under a duty of candour to stop them
covering up for financial pressures and dishonestly claiming that changes are
“clinically led”. If the money is not there to run a full range of appropriate services,
NHS managers should say so openly, and put the focus back onto the politicians whose
decisions on funding are to blame.
The recommendations are amongst 18 made by the innovative People’s Inquiry, which has
been conducting a health check of London’s NHS after almost a year of the Health &
Social Care Act. The Inquiry’s report London’s NHS at the Crossroads, published
yesterday – reveals serious concerns.
Mental health is causing especially strong concern. Budgets nationally have been cut for
the past two years, and the ‘tariff’ paid for treatment next year is facing the deepest
cuts of all.
Severe shortages of acute mental health beds mean more patients being placed at high cost in private beds, often at long and awkward distances from their homes, friends and
family, said Dr Martin Baggaley, medical director of South London & Maudsley Foundation
The report gives illustrations of the nonsense of a market in health care. Specialist
forensic mental health beds have been commissioned at the notionally lower cost of beds
in the private sector.
But the private sector is only cheaper because it is a low-skilled service, with a fee
crudely calculated by the day. The lack of professional staff means that patients on
average stay far longer – pushing up the actual cost per episode of treatment – and are
more likely to reoffend and wind up back in treatment. So any apparent short-term saving
is achieved only at the expense of higher real costs and a much poorer service.
In total 95 witnesses, ranging from Trust chief executives and the former chief executive
of London’s Strategic Health Authority to individual patients, campaigners and health
workers spoke to the Unite-sponsored Inquiry, contributing over 30 hours of evidence at
seven public sessions, as well as written evidence. The panel was chaired by health
commentator Roy Lilley and included Polly Toynbee, Professor Sue Richards of Keep Our
NHS Public, Dr Louise Irvine of Save Lewisham Hospital, senior NHS manager Naledi Klein
and trade unionist Frank Wood.
Common concerns included the absence of any strategic body with the scope to plan and
organise services across the capital, the fragmentation of the NHS – which can only
worsen as Clinical Commissioning Groups are compelled by the Act to put more and more
services out to tender – and the massive and tightening financial squeeze on the NHS.
The new competitive health care market opened up by the Act is a problem, say
commissioners, providers and the public. In many areas campaigners and the wider public
complained of uncommunicative commissioners and desperate cost-cutting by providers which is undermining the quality of care.
Among the 18 recommendations from the Inquiry Panel there are calls for more transparency and accountability, the reversal of the Health & Social Care Act, and the repeal of the controversial “hospital closure clause”, which the Panel warn would simply
institutionalise decision making without local consultation or local support from
clinicians or the wider public.
Which brings us to the first and possibly most contentious of the recommendations: an end to George Osborne’s unprecedented and tightening squeeze on NHS finances, which has effectively frozen the budget in London and across the country, as demand and cost
Osborne’s plans, confirmed in the Budget, would continue the freeze on funding through
to 2021, creating a £30 billion funding shortfall nationally, and a London shortfall of
After the four meanest-ever years for growth in NHS funding, and with many trusts and
some CCGs already deep in financial trouble, this would spell disaster.
Deeper problems up to now have only been avoided by the generosity of funding in the
years of Labour government.
The panel does not attempt to second-guess how any extra money should be raised for the NHS, but it is quite clear that the Tories and Lib Dems are committed to continuing cuts in public spending – and Labour so far appears to be headed in the same direction.
Let’s get real. Without a resumption of proper funding to the NHS, none of its problems
are going to be resolved. And any government that crash-dives the NHS is likely to face
the anger of voters. So for Labour it’s a no-brainer: sign up as the party that would
once again rescue our NHS from a decade of Tory cuts, or face the consequences.
Unite has declared its commitment to campaigning for the Inquiry’s recommendations in the Labour Party and the wider trade union and labour movement. They could provide an
important extra backbone to lend teeth to Labour’s latest policy document on health, and
reinforce the campaign for health and social care to be integrated in the public sector.
The marketization and privatisation embodied in the Health & Social Care Act are
undermining existing public sector providers, pushing up costs, fragmenting services and
failing patients. Lansley’s Act has created an NHS that is unstable, inefficient and
increasingly secretive and unaccountable. Services are only being kept going by the
dedication of an increasingly weary and demoralised workforce facing non-stop cuts in
real pay, relentless increases in workload, and bullying from desperate managers.
The People’s Inquiry offers a formula to address these questions. It’s tailored to the
situation in London – but many of the issues addressed and proposals are also relevant to
other parts of England.
Transcripts of the Inquiry’s seven hearings and many of the submitted documents can be viewed or downloaded at http://www.peoplesinquiry.org/. The Full report is also available, along with an Executive Summary. I hope campaigners will find them a useful resource and a weapon in the fight to save our NHS.
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About the author
John Lister of London Health Emergency is a writer and academic who has campaigned against NHS cutbacks and privatisation for almost 30 years. He has taught journalism and health policy at Coventry University, is a founder member of Keep Our NHS Public, and a board member of the International Association of Health Policy.
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