What goes around, comes around
Posted on 23 January 2013 by Andrew Bamji
It is sad to see what short memories people have of the failed SLHT (South London Healthcare NHS Trust).
Had the original proposition gone through, a rationalisation of the emergency departments of Lewisham Hospital and Queen Elizabeth Hospital Woolwich would have been inevitable and, with a similar pairing of Queen Mary’s Hospital Sidcup and the Princess Royal University Hospital, in Farnborough, a working model might have been achieved.
Instead, Queen Mary’s was destroyed by the removal of its emergency department and maternity services and some folk at Lewisham Hospital congratulated themselves on their lucky escape.
So, as an erstwhile consultant at Queen Mary’s, condemned to a second-class existence as all my acute colleagues disappeared from the site, with no continuing medical education opportunities available, and taking early retirement from the NHS as a result, it is with schadenfreude that I observe that the SLHT octopus has ensnared Lewisham at last.
There is nothing special about Lewisham that did not also apply to Queen Mary’s.
Even the finance directors of the four hospitals predicted, before SLHT was created, that the PFI (private finance initiative) burden was unsustainable — I was accused of scaremongering when I argued this at the time but was proved right.
But looking at the figures I still conclude that, if the PFI debt was written off and future payments were covered in full, then all four hospitals could have survived unchanged and in financial balance.
So it appears that trust special administrator Matthew Kershaw, without prejudice, has come to the conclusion that I, and many of my Sidcup colleagues, reached five years ago.
I congratulate him on his boldness but a nightmare could have been avoided had our concerns been taken seriously at the time.
When I started as a consultant in 1983, hospital managers were there to facilitate the plans devised by the clinicians. When I finished, in 2011, consultants were bullied threatened and coerced into following the plans devised by managers.
Financial balance has become the prime issue for hospitals and patient care must fit into the financial straitjacket. This is incompatible with maintaining clinical services.
There are economies of scale in large units, which is why we have superstores, and that is also why the concept of care in the community based around community hospitals is not financially sensible. Perhaps people with short memories should think back to the 1980s and ask why the extensive and clinically effective cottage hospital network was slowly closed.
If we are to make anything out of the catastrophe that is the SLHT, we should re-examine the purchaser-provider split that sets GPs against hospitals.
Turning Lewisham Hospital (and Queen Mary’s) into integrated care centres where GPs and specialists work together might restore my faith. If that is unaffordable, then they should close altogether. It might be better to have excellent services on two sites than substandard ones on four.
Of course that presupposes that there are enough beds in just two hospitals to cope with emergency demand in south London. Actually there aren’t enough with four. The health secretary should implement Mr Kershaw’s recommendations in full, and immediately. Other trusts face similar problems; SLHT is the first of many to come.
Andrew Bamji is an East Sussex consultant in rheumatology
private finance initiative