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Main » 2010 » January » 25 » Healthcare In London Heading Towards Financial Crisis, Say Doctors
Healthcare In London Heading Towards Financial Crisis, Say Doctors
Hospital services in London could close or be down-graded as healthcare in the capital heads towards "a major financial and organisational crisis", with the imposition of real term cuts of £5 billion by 2017, according to a new BMA report launched yesterday (Wednesday 20 January 2010).

The report, 'London's NHS ON THE BRINK', written by health expert John Lister2, was commissioned by the BMA's London Regional Council. In the report, Lister surveys board papers and other published material from primary care trusts (PCTs) in London.

It is expected that from 2011 there will be a freeze on NHS budgets, says the report, but the brunt of the cuts will fall on London.

London faces unique challenges - it has 14.8% of the English population, but could face a much higher share of the expected cutbacks. There are more mental health patients per head of population in London than other English regions, the capital has rising patient activity and it has a number of very expensive Private Finance Initiative (PFI) hospital schemes. The repayments for London's twenty PFI hospital projects will have a lifetime cost of around £16.7 billion - more than six times the basic cost of the buildings.

In the report, John Lister highlights some of the proposals that NHS London has made public, including:

- The aim to reduce the number of people going to hospital accident and emergency departments by 60% and the number going to hospital outpatients by 55%.

- Millions of patients would be diverted to unproven "polysystems" or clinics that have not yet been built. These changes would cut upwards of £1.1 billion from hospital budgets in London, forcing wide scale cutbacks and closures, according to the report.

- A 66% reduction in staffing of non-acute services, these include community services for older people and district nurses.

- A 33% cut in the length of GP appointment times.

- Slimming down London's hospital network, reducing many district general hospitals to lesser "local hospitals", and leaving just a handful of "major acute" hospitals.

- Annual reductions in the "tariff" that determines how much hospitals are paid per item of treatment.

The study emphasises a lack of transparency in the way NHS London has drawn up its plans to respond to the expected freeze on NHS budgets. NHS London has refused Freedom of Information Act requests to release a confidential report drawn up for them by US-based consultancy McKinsey's, effectively denying interested parties any opportunity to scrutinise its underlying assumptions or supporting evidence, says the report. However, some published reports have indicated that London PCTs will face a funding gap in the region of £5 billion by 2017 (the health budget for London in 2009/2010 was around £13 billion).

Chairman of the BMA's London Regional Council, Dr Kevin O'Kane, said today:

"While we recognise that there are problems with healthcare delivery in London, we are extremely worried that plans to cut services are being kept secret. We are calling for full disclosure of the proposals so that there can be a public debate. This is vital so that Londoners can have their say about local cuts and take a wider view of what is happening to the NHS.

"The truth is that most Londoners have no idea of what is happening to their health service. If people realised that we are heading towards financial meltdown involving cuts in bed numbers and hospitals closing or being down-graded, they would demand the opportunity to make their voices heard about these plans.

"London's doctors want to provide patients with world class healthcare but this is virtually impossible when doctors and patients are being kept in the dark about proposals. Lord Darzi pledged that all changes would benefit patients, be locally led and that existing services will not be withdrawn until new and better services are available to patients so they can see the difference. He also said that health professionals would be engaged in the plans. London's doctors are not opposed to change, but we would like to see Lord Darzi's principles applied meaningfully to the process."

The report analyses the financial situations of the six sectors, formed in March 2009, that cover PCTs in London - North West London, North Central London, Outer North East London, Inner North East London, South East London and South West London.

The London Regional Council believes that NHS market reforms are partly to blame for the damage to the health service in London and elsewhere. The BMA's campaign, Look After Our NHS, is calling for an NHS that:

- Provides high quality, comprehensive healthcare for all, free at the point of use.

- Is publicly funded through central taxes, publicly provided and publicly accountable.

- Significantly reduces commercial involvement.

- Uses public money for quality healthcare, not profits for shareholders.

- Cares for patients through co-operation, not competition.

- Is led by medical professionals working in partnership with patients and the public.

- Seeks value for money but puts the care of patients before financial targets.

- Is fully committed to training future generations of medical professionals.

The British Medical Association
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