People’s Inquiry – a grassroots vision for our NHS? By John Lister

14 October 2013 — Our NHS

As the NHS groans under cuts and chaotic reorganisation, government bodies are calling for yet more ‘radical change‘ and ‘difficult decisions’. Will their answers be hospital closures and privatisations? The new People’s Inquiry is calling for evidence to support a different way forward. 

Campaigners fighting hospital closures, cutbacks and the erosion of mental health and other services have years of bitter experience of presenting solid, evidence-based arguments in “consultations” that ignore them and press ahead regardless. I know. In almost 30 years, I’ve been there with them too many times.

So the chance to outline the campaigners’ case to an independent Panel in a series of public hearings on the developing crisis in London is a really useful opportunity to focus attention once again on the issues and arguments that in any genuine debate would have won the day, or at least forced a serious reply.

The Peoples Inquiry is a bold initiative funded by Unite the Union, but open to all those who want to take part. It will formulate a report on London’s NHS to be published in the new year. This will be a resource for campaigners, a tool to persuade politicians, and a pressure on those forcing through controversial proposals in the teeth of local opposition.

It’s a genuine effort to piece together the jigsaw, and develop a picture of the NHS in London, and kick-start fresh debate on how it should proceed.

This is no phony NHS “consultation”: we really hope to reach out on the widest possible basis.

The Panel’s task is to bring together verbal and written evidence and piece together a picture of the situation shaping up in the NHS right across London.  It’s chaired by NHS commentator Roy Lilley, and includes the Guardian’s Polly Toynbee, alongside campaigners and union activists.

But many campaigners have become too used to having their views brushed aside: too used to having to hold their own public meetings as the only platform to allow their opposition to be discussed – and the idea of formulating their arguments as evidence may seem strange.

There’s no fixed formula. The shape of each verbal submission will vary according to the issue. But in each case the point to focus on is that the Inquiry is trying to get an idea of not only the facts and figures of what’s happening, many of which can be gleaned from published sources, but also as far as possible at the impact of changes and cutbacks – on patients, their families, communities and health workers. 

Personal stories, accounts of what it feels like for staff on the frontline and patients who depend upon threatened services will be very effective.

The Inquiry will also be asking CCGs and NHS Trusts and Foundations to set out their view, so the more hard evidence there is of the human impact, the better these accounts can be put into perspective. Written evidence is also welcome, where necessary this can be submitted anonymously online.

The Inquiry is also very keen to go beyond the obvious issues of hospital cuts and closures – to discuss mental health, the interaction of NHS with social care, and wider issues, knowing there are few, if any, big issues in the NHS that are not unfolding in London.

Three years of frozen pay for NHS staff, at a time of rising inflation, have effectively cut the value of wages by 12 percent, exacerbating recruitment problems in many London hospitals as housing costs continue to rise in the capital; the result – rising Trust spending on agency staff. But the government wants even deeper cuts in pay and conditions for NHS staff.

NHS budgets, too have been effectively frozen, with only the most microscopic real terms increase since 2010, making 2010-2014 the meanest-ever five years for NHS funding – while pressures on NHS budgets increase costs by an average 4% annually.

In response to this, the government has embraced the £20 billion target for cash savings across the NHS outlined in a controversial McKinsey report for the Labour government in 2009. NHS London decided London should take a lion’s share of these savings, setting a target of £5 billion.

In the quest for cuts, a detailed map of the capital in NHS London’s “Integrated Strategic Plan 2010-2015” in January 2010 showed that in 23 out of 40 hospital sites the future was undecided, and two hospitals were already due to lose most of their acute inpatient and all of their emergency services.

But from the beginning the proposed reductions in hospital care and “shift of activity” to supposedly “lower cost settings” have been detached from any concrete plans for expansion of community services and primary care to take the additional workload.  Plans to replace A&E units with Urgent Care Centres are based on highly contested assumptions.  And while the focus has been on acute services, mental health care in the capital is also under growing strain.  

London’s boroughs, too, and the social care they are supposed to provide, have been subjected to a continual cash squeeze, reducing services in many areas restricted only to those with the most serious needs, while others are left to cope alone. The result? Ever-rising use of emergency NHS services.

Add to this mix the organisational chaos brought by the Health & Social Care Act which scrapped the existing commissioners, broke up NHS London,carving the capital into three, and dumped responsibility for huge budgets onto Clinical Commissioning Groups (CCGs) supposedly led by GPs, while giving real control to shadowy Commissioning Support Units.

With untested CCG leaderships, implementing unproven ideas, the situation is now further confused by the requirement to open up a growing range of services to competitive tender, with competition rules preventing GPs from taking back control of Out of Hours services, and obstructing mergers of hospital trusts.

Control of specialist services is now in the hands not of Clinical Commissioning Groups, but NHS England, whose disruptive intervention in London has already undermined quality care, with the switch of a “gamma knife” contract from the existing highly-skilled team at UCLH to private providers at Barts and the BUPA Cromwell Hospital.

London was the first area to face the draconian powers of the “unsustainable provider regime,” used to tackle the growing deficits at South London Healthcare Trust – leading to a £1 billion package that included brutal cuts at the neighbouring Lewisham Hospital, which have since been overturned by a judicial review.

At the centre of the South London Healthcare meltdown were two disastrously over-priced Private Finance Initiative schemes, which built hospitals worth £210 million but which will cost £2.3 billion or more. These are not the biggest or the worst PFI schemes, and others in the capital can now be seen triggering cuts and chaos – notably the £300m Queens Hospital in Romford and the £1 billion Barts and Royal London scheme which is now forcing cuts in the country’s biggest Trust, Barts Health.

Barts and other cash-strapped Trusts have turned to staffing cuts, scaling back numbers of senior nurses – who are key to maintaining quality patient care.  

The stories go on.

But NHS London has been now scrapped. Most of the records of its activity since 2009 are in obscure archives on the British Library website.

With no unifying body to keep track of changes or stand up for health care in Europe’s biggest city, the Peoples Inquiry is trying to uncover the true picture.

We hope campaigners will take the chance to respond. Right now, almost nobody else is listening. Let’s make them.


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