Allyson Pollock’s report now published click here to download

Allyson Pollock’s report Blaming the victims:the trust special administrator’s plans for southeast London presented at the Lewisham People’s Commission and published today shows how the devastating effect of  PFI debts in the South London Health Trust are behind government plans to downgrade and close Lewisham Hospital

Government policies for the NHS – ignoring the health care needs of south east London

In a new report on South London Healthcare Trust, we show that major service closures, staff redundancies, and the sale of NHS land and hospitals across south east London are the result of the government not acting in the interests of the health service. They are, in fact, the product of a process of financially-driven service change devised by government and of a type criticised by the Francis inquiry into Mid-Staffordshire.

The secretary of state made the decision on the closures in January 2013 in the light of the report of the trust special administrator (TSA) for the South London Healthcare NHS Trust (SLHT), whom he appointed in July 2012. Our report shows that the TSA has made no public health case for downgrading services and has provided no sound evidence for the policy.

We point to a number of government policies that have created the situation in south east London, including the exorbitant, increasing, yet unclear cost of SLHT’s longstanding PFI deals, the reduction in the prices paid for hospital attendances and admissions (the national tariff) as a result of an efficiency programme known as the QIPP, and a policy of allowing foundation trusts, such as Guy’s and King’s, to retain surpluses, depriving SLHT access to funds.

The TSA, however, asserts that that underperformance is in part due to mismanagement, including excess spend on locum costs and agency staff, and makes a number of productivity criticisms including the costs of lack of integration and low income per consultant and other staff. However, we show that the data and methods behind these claims are mainly derived internally, have been insufficiently analysed, and cannot be verified.

Furthermore, the TSA makes no needs assessment such as analysis of patient flows, changes in referral patterns and activity, bed capacity, staffing, and bed norms modeled against need, referring rather to travel times, a MORI opinion poll, and proxy productivity measures.

The major closures, redundancies, sell-offs, and service reconfigurations that will follow the TSA regime for the SLHT do not serve patients, whose needs have been, at best, down-played and at worst ignored. In the case of Lewisham hospital, there can be little doubt that the government is sacrificing a thriving local hospital in order to protect the interests of bankers, shareholders, and corporate stakeholders. The victims here are the people of south east London and those who work in and use the health services there. If the secretary of state implements the TSA recommendations, the public health consequences are likely to be catastrophic.