On 24 November demonstrators against the cuts at Lewisham Hospital will assemble at 2pm at Loampit Vale roundabout, next to Lewisham DLR and rail station, and march to the hospital.
Accident and Emergency, maternity, and complex and emergency surgery services at the hospital are set for closure under plans to break up the South London Healthcare Trust, which earlier this year went bust because of its spending on expensive PFI contracts.
A public protest meeting on 8 November drew maybe a thousand people, and the march is expected to be one of the largest ever against local hospital cuts.
Debates are in progress on the best way to defeat the cuts and save the hospital.
From the mid-1970s through to the early 1980s, several hospitals and wards were occupied by workers and their supporters. In many cases they stopped closures.
Between 1976 and 1978 there were approximately ten work-ins or occupations in hospitals; between 1976 and 1982, around 28 occupations.
The hospital or ward was run by the staff. Patients were cared for. Equipment stayed in place.
The Elizabeth Garrett Anderson Women’s Hospital (EGA) in Central London was occupied from 1976 to 1978.
The EGA was first threatened with closure in 1974. The Nursing Council backed down after 23,000 women’s signatures were collected in defence of the hospital.
In 1976 David Ennals, the Labour health minister, threatened closure. Some workers occupied Health Authorities. 700 workers staged a Day of Action and marched on the House of Commons.
In November 1976 100 nurses and 78 ancillary staff began an occupation of EGA, demanding that the Area Health Authority do essential maintenance to the run-down buildings. Pickets outside held a banner declaring: “This hospital is under workers’ control”.
The occupation was run by committees set up through general meetings — the Joint Shop Stewards’ Committee, the Medical Committee, and the Action Committee, which was made up of reps from all sections of staff, including consultants.
The occupation required a manager to be on-site at all times in order for the insurance to be valid. At EGA this meant the hospital secretary.
In 1978 the hospital was threatened with closure again and a big demonstration stopped the traffic on Euston Road. In 1979 EGA was reprieved as a specialist gynaecology hospital.
The EGA building has since been closed, and its services moved (in modified form) to the nearby UCL Hospital. But the occupation was a success.
Occupations and work-ins at hospitals threatened by closure force management to keep providing the service, and enable workers to create a rallying point and an alliance with people who would be deprived of the service if it closed. As John Lister said in a London Health Emergency pamphlet Occupy and Win, published in 1984:
“It is not certain that occupying a threatened hospital will keep it open, but it is certain that if you do not occupy it will close”.
A Lewisham hospital worker spoke to Solidarity:
"This has happened because of the debts that have built up from the PFI schemes in the South London Trust, but I think that they’re picking on Lewisham because the Tories know they’re never going to get in here.
The Lib-Dems and Tories know they’ll take a hit in the ballot box in Bexley and Greenwich, so they’re trying to save money here instead. It’s because there’s a load of Etonians running the government. It’s because it’s a Tory government.
The hospital will be done for if they shut the A&E. The A&E is always really busy. I can’t see how it will work if the patients have to travel to Woolwich. The A&E has only just been refurbished. It doesn’t make any sense to shut it.
It doesn’t sound like a good option to merge with Queen Elizabeth Woolwich, a Trust that was overspent by £1.3 million per week.
I’m definitely going to be at the demonstration on 24 November. Some people think that whatever we do they won’t listen. But I was surprised about how big the meeting was. We got them to change their mind when they wanted to shut the A&E in a previous consultation, “A Picture of Health”, so we’ve got to do that again.
I’m in the RCN (Royal College of Nursing) like most people I work with, but I haven’t heard anything from them. My colleagues, and the patients I work with are really concerned, but I couldn’t really comment about the unions.
There are definitely problems here. But getting rid of services is no way to make things better. We need maternity and A&E services here.
I’m sure there are efficiencies that could be made if services were better organised, but some areas need to be better staffed, and there’s a lot of work to be done in training staff to get really good services here.
The NHS cannot continue to be a comprehensive health service if it continues to be funded the way it is. There just isn’t enough money allocated.
Healthcare becomes more expensive all the time, as new expensive treatments become available. Pharmaceutical companies, with their patents, charge the NHS large amounts of money.
Even as it is, the NHS is not really able to provide the best level of care to everyone. The treatments that people get vary according to where they live."
Around 26 accident and emergency departments are scheduled for closure across the country.
Emergency departments account for a relatively small proportion of the NHS budget (5.1% in London), so what is behind this wave of closures?
In the last ten years there has been a centralisation of specialist emergency services, including for major trauma, cardiac and stroke care. This change has been partly based on evidence that departments treating larger numbers get better results; but it has also meant these services are further away for many people.
With those changes established, only a minority of A&E departments treat all emergency conditions. That leaves the remaining units vulnerable to being replaced by Minor Injuries Units or GP walk-in centres.
But it has been shown that only ten to thirty per cent of A&E patients could be safely treated in primary care alone. The walk-in centres and Minor Injuries Units have been very expensive and do not take much strain away from emergency departments.
In many other cases the “alternative community provision” does not exist, and the closure of an A&E is simply a cut. In the current plan for closure in north-west London there is a planned cut of 14% of A&E attendances (100,000 fewer patients), with no substantial increase in alternatives.
Emergency departments are not only the public face of many hospitals but also a key part of core clinical services. The loss of an emergency department reduces demand for intensive care and high dependency beds in the hospital. Less emergency surgery is carried out, and it can then be argued that the emergency surgery would be better done in a busier centre.
As services wither it becomes harder to recruit medical and nursing staff. The closure of A&E departments is often the first step towards decline and closure of a district hospital.
Despite excellent clinical outcomes, South London Healthcare Trust has failed to balance its books because it is bled dry by PFI (Public Finance Initiative) debt.
Last year the Trust “overspent” by £65 million and paid out £69 million on PFI. Instead of cancelling the debt, the government wants to close down wards and services.
Private Finance Initiative (PFI) was a scheme set up by the Major government in the 1990s and continued with enthusiasm by New Labour.
PFI allows a consortium of private investors (usually a mixture of finance, construction and service industry capitalists) to build and maintain a public building, like a hospital, and then rent it back to the public like a massive hire-purchase scheme.
The consortium also locks the public sector into extortionate maintenance contracts. After several decades of extortion the building eventually falls into public ownership.
A lot of the PFI contracts were sold off after the initial building work. Carillion, for example, sold its rights to future PFI income from Portsmouth’s Queen Alexandra Hospital for £31 million after an initial investment of just £12 million (160% profit!).
According to analyst Dexter Whitfield, a great majority of PFI assets are now held by private individuals in offshore tax havens.
If the government wishes to borrow money for big capital investment projects (like building hospitals), it can do so at rock bottom rates. By using PFI, the government is choosing to pay more (to the private contractors) for less (for the NHS).
Total PFI payments will reach £65 billion by 2048 — for hospitals that cost just £11.3 billion to build. Three major PFI hospitals in Norwich, Peterborough and Chelmsford cost £642 million to build but will end up costing the NHS £4.25 billion by 2043.
South London Healthcare now pays out 15% of its operating budget on servicing PFI.
Allyson Pollock states: “the high costs of PFI debt charges means that the NHS can only operate anything from a third to half as many services and staff as it would have done had the scheme been funded through conventional procurement. In other words, for every PFI hospital up and running, equity investors and bankers are charging as if for two”.
The socialist solution is to cancel the debt and take the hospitals into public ownership. By doing that we can liberate the NHS from its role as a slush fund for private investors and free up taxpayers’ money to be spent on equitable healthcare.
Labour pledged at its last conference that it would “liberate the NHS from extortionate PFI debt”; but the Labour leadership will need to feel the force of a mass working-class movement behind them before they stand up to capitalist class interests and reverse their former policy.
Even the Tories could easily take the PFI debt onto the public accounts, thus cancelling it for South London Healthcare Trust and enabling it to continue without closures.
How they won at the Whittington
Shirley Franklin is chair of the Defend Whittington Hospital Campaign, which in 2009-10 defeated plans to close the A&E and other departments there. She spoke to Solidarity:
"We had petitions – not just e-petitions, but also petitions we took onto the streets. We collected about 25,000 names altogether, of which about 20,000 were got face-to-face, on the streets. That was hard work, but it was important.
Support from the Islington Tribune played a crucial role. Someone had told [local Labour MP] Jeremy Corbyn about the closure plan. As soon as the news leaked out, there was a public meeting. That first meeting was huge, and the campaign just kept getting bigger.
We called ourselves a coalition. It was a cross-party thing; we got local Lib Dem and Labour members involved. We even had a bunch of Tories from the Highgate Society come down to get involved!
The other thing that was crucial was the involvement of unions. We went to their meetings and asked for donations, which was a way of engaging with them and getting them involved. On our final day of action, we had activities right across the borough – not only outside health centres, but at post offices, at the bus garage, at universities, at colleges, at schools. Everyone was involved.
Dealing with the involvement of people like [Tory health spokesperson Andrew] Lansley [who offered support to the campaign] was difficult. Lansley spoke at the demo saying that the A&E would be safe in Tory hands; we got all that on the website, on tape. None of us could quite believe he’d said it.
I think we saved the hospital. If the A&E had gone it would’ve been a first step towards closure. But there have still been massive cuts to A&E. They’ve cut the staffing right back, and there are worse waiting times than ever.
The Unison branch at the Whittington hadn’t even had a general meeting, and our encouragement and engagement helped them to have one. It was hard to engage with workers at first, because health sector unions are very intimidated.
When we first organised actions at the hospital, managers told workers they’d be sacked if they attended in uniform. But their involvement is irreplaceable."