London's health care under further attack

YOU CAN see what the growing gap between the rich and poor means in life and death terms by looking at health care in London. If you travel just seven stops on the Jubilee tube line from Westminster to Canning Town in London's east end, the average life expectancy for men plummets from 77.7 years to 70.7 years.

Chris Newby

Infant mortality stands at 8.1 per thousand births in the poorer borough of Haringey in north London compared to 2.7 per thousand births in the more prosperous area of Richmond. Yet health funding in north-east London, with some of England's lowest life expectancies, is £1,090 per head of population compared to north-west London with funding of £1,311.

This is the situation that confronted Lord Darzi, surgeon and government health minister, when he produced his report on London health care, A framework for action.

Private sector

He writes in this document about wanting to drastically improve health care for Londoners and that he feels "passionately that Londoners deserve world class health care." But throughout his report are statements such as: "these changes are necessary not just to improve services but also to make future activity affordable" and: "the private sector will also be a partner in making this framework happen."

The key changes that he proposes are the abolition of all district general hospitals in London and replacing them with a series of specialist treatment centres, smaller local hospitals and polyclinics (larger GPs' surgeries with additional facilities such as pharmacies and facilities for minor operations).

Darzi talks of the need to develop specialist hospitals so that health workers would be treating enough patients to develop their skills. Darzi hopes that polyclinics bring health services closer to the community. The aims of more specialist hospitals and more community services are laudable but this should not be at the expense of maintaining and improving already overstretched local services.

What is apparent in this report is the drive to cut costs to the scale of £1.5 billion and the increased involvement of the private sector. The day after Darzi released his report, health secretary Alan Johnson announced private companies' involvement in the provision of these polyclinics.

Devastation

IF THESE proposals happen, they will devastate health care in London with half of the capital's Accident and Emergency (A&E) departments being closed. London's population is expected to rise 8% by 2016, but Darzi proposes a 6% cut in the number of beds.

In Sidcup in south-east London, the local NHS trust is using this report as justification for its plans to close the A&E department and other services at Queen Mary's hospital. In the four local hospital trusts including Sidcup there is a "legacy debt" of £180 million.

Sidcup's hospital trust is paying the price for not being locked into a very costly Private Finance Initiative (PFI) deal.

The other three trusts - Woolwich, Lewisham and Bromley - are. This makes it cheaper to cut services in Sidcup and sell the land rather than to cut services at these hospitals with PFI contracts that they are locked into for another 30 years.

With services being cut in Sidcup, it would make the journey time to find similar services a lot longer for people and would put massive pressure on the other hospitals. Queen Elizabeth hospital in Woolwich would face a 47% increase, 6,000 extra patients a year, in the number of emergencies it would have to deal with without any significant increase in its income.

The money is there already that could dramatically improve the level and quality of health care throughout Britain, not just in London. PFI is having a devastating effect on NHS funding. NHS trusts are paying £52 billion over 30-60 year contracts for original construction costs of £8.5 billion. This could rise to between £91 billion and £170 billion according to an MPs' report.

The government should immediately cancel these PFI contracts and bring all NHS buildings and land back into public ownership, and bring an end to the marketisation and privatisation that currently exists in the NHS.

'Consultations' are already taking place in London on these proposals. We urge as many people as possible to get along to these consultations to make the case for an NHS that is genuinely publicly owned and financed and free at the point of use.