Health Secretary Andrew Lansley only has one mantra for addressing health care issues – “the market! the market”! This is demonstrated by his response to two different NHS Trusts in London facing challenging and uncertain futures.
In the Barts and the London Trust, Barts – Britain’s oldest hospital, dating back to 1123 and one of our leading cancer and cardiac specialist centres – has a new £1.3 billion Private Finance Initiative hospital scheduled. Leaving alone the disaster of PFI and its inherent associated debts, Barts will be further cursed by having its commissioning decided by the local general practitioners. The GP consortia, still in the process of being established, will have to make a decision: support this state of the art hospital, covering a catchment area of effectively 4.5 million patients, and in the process rationalise lesser specialist hospitals in their area by moving them to Barts; or not support Barts and leave the antiquated and outmoded hospitals intact. The latter choice will mean that patient care will suffer and that the billions invested in Barts will be wasted as it will go bankrupt.
Lansley’s response to this economic threat to Barts is effectively “let it go bankrupt, ‘the market’ will resolve the problem”. In other words, Barts will be asset-stripped by a private health provider. The GPs, if they want to keep their patients alive, will have no choice but to buy into the privatised provision.
In completely opposite circumstances, South London Healthcare NHS Trust presents another gloomy picture. South London Healthcare was the shotgun marriage of three Trusts – Queen Mary’s Sidcup, Queen Elizabeth Hospital and Bromley Hospitals. Bankrupted by years of management incompetence, it inherited debts of £100 million. These are PFI debts that will ruin the hospitals financially. The marriage was a radical attempt to slash costs and turn the situation round.
These hospitals have suffered years of continual political interference by politicians in South East London and Kent; now it has just got worse. The Lansley solution is once again: “the market”. The marriage is to be dissolved, its assets shared out. Queen Mary’s, a political bribe to the Tories of Sidcup from the late Edward Heath, is already being piloted as a GP consortia buy-out – another private hospital built on public money. Bromley is tipped to be snapped up by a private health provider, probably a multi-national. Queen Elizabeth and Greenwich, based on the old army hospital in Woolwich, is likely to be asset-stripped and reduced in function. For patients in South East London, especially the poorer areas of Woolwich, Charlton and Erith, which have suffered decline since the closures of the manufacturing base in the 1970s, healthcare provision looks grim.
So here are two radically differing examples of healthcare provision in London, both being offered the only medicine in town – “the market” – so medicine that will not help any hospital get better. For example, Barts needs to be relieved of the crippling PFI debts which guarantee bankruptcy. Systematic healthcare planning, based on an integrated model, needs to be introduced and the commissioner/provider internal market split needs to be abolished. It is just a licence to print money. Lansley’s solution of selling off to the private healthcare providers NHS hospitals deemed to be failing or bankrupt has to be opposed. Otherwise it will only be a question of time before all the assets of the NHS are handed over to private interests. Londoners must fight for what is theirs.