SW London Hospitals

SW London hospitals Under PRESSURE Researched and written for BWTUC by JOHN LISTER, Information Director of London Health Emergency Published by Battersea and Wandsworth TUC Under PRESSURE Under Pressure A survey of health services in South West London (the new Strategic Health Authority area, covering the six London Boroughs of Wandsworth, Merton, Sutton, Kingston, Richmond and Croydon). Researched by JOHN LISTER of London Health Emergency for Battersea and Wandsworth Trades Union Council. Introduction Health services in South West London have been ripped apart by more than two decades of systematic underfunding, cuts, closures and privatisation. Capacity has been cut to the bare bones and the pressure on the remaining services has been jacked up to dangerous levels. Staff pay has been held down to scandalously low levels, with the end result that hospitals like St George’s are racking up multi-million pound deficits in agency fees as they try to balance the books. Hundreds of other staff have seen their jobs knocked down to the lowest bidder in the dash to privatise. This was the year that we were supposed to turn the corner. Gordon Brown had pledged that budgets would be increased and that rather than cuts, service improvements would on the agenda. This report shows in graphic detail that not only has that not happened in South West London but that, in fact, our hospitals and primary care services are staring down the barrel of multi-million pound deficits that will require further cuts to balance the books. Battersea and Wandsworth TUC represents not only those who work in our health services but those who use them as well. Our fight for high quality public services runs alongside our fight for decent wages and housing for the people we rely upon to run them. This report will be used as a campaigning tool to argue the case for the investment that we need to drag services up to an acceptable level. We are the real modernisers, not the accountants, bureaucrats and cuts merchants who have dragged us in to this shambles. Geoff Martin Battersea and Wandsworth TUC Lead Organiser February 2003 2 Under PRESSURE Executive summary THE CURRENT cash crisis facing the main hospital The report concludes by offering a number of Trusts in SW London – a £5-£7m deficit at Epsom/St recommendations: Helier, £4m-plus at St George’s, and an underlying Runaway costs of employing agency staff to recurrent £3.9m-plus deficit at Kingston – are the lat- plug gaps in the full time NHS workforce have to be est symptoms of years of under-funding of health tackled. Because of national agreements covering services in SW London. NHS pay, this cannot be done at local level: it The body of the report shows the consistent pat- requires a fundamental rethink of government policy, tern of under-resourcing and crisis measures running including a substantial uplift in London weighting and back to the early 1980s. a further increase in the pay for all grades of nursing ! The area has now received a below-average staff. In addition, NHS Trusts must begin to take seri- increase in spending for the next 3 years, with ously the need for more flexible and family-friendly Wandsworth facing an estimated £5m shortfall over policies to enable them to retain and attract back that period as a result of a new funding formula. nursing and other staff who prefer to work part-time The StHA calculates that more than 300 extra or particular hours to suit family responsibilities. beds are required to meet local pressures over the There is an urgent need for a thorough and next 3 years, but current plans fall almost 200 beds independent audit of the financial situation in all local short of this – forcing health chiefs to contemplate NHS Trusts, to establish a realistic baseline budget sending local people to out-of-area NHS Trusts or that will sustain the necessary level of services – and costly private beds in order to meet government tar- the additional money must be made available, to gets. ensure that services are expanded as required on a The situation will be compounded in April by stable and sustainable basis. the imposition of the government’s new London This audit must also include the allocation of Patients Choice policy, which will encourage patients sufficient resources to enable the Trusts to build, staff who have been more than 6 months on waiting lists and operate the additional 200 beds that have been to opt for treatment elsewhere: given the lack of identified by the Strategic Health Authority as local capacity in SW London, this will inevitably required to deliver government targets for access, siphon even more cash out of the budgets of local quality and waiting times. Trusts. Any planned deals with private hospitals should Local Trusts continue to be destabilised by sky- be abandoned, and priority should be given instead to high spending on agency staff to fill nursing and other the most rapid possible expansion of local NHS vacancies. But the diversion of more NHS patients capacity, alongside longer term plans for the renewal for private sector treatment will further intensify the of old and obsolescent buildings. competition for scarce nursing and professional staff Privatised support services which generate – worsening the plight of the NHS Trusts. profits at the expense of low pay for staff must be The latest ill-conceived plans to replace Epsom brought back in house, with staff properly reincorpo- and St Helier with a single PFI funded hospital to rated into the NHS team cover 800,000 people would have dire knock-on con- With the government currently able to borrow sequences for overstretched services at St George’s, money on the international markets at 2% interest or Mayday and Kingston. even lower, all PFI schemes should be abandoned as The most likely site for a single site hospital, too costly and inflexible to suit the needs of the NHS. the Sutton Hospital site, is too small to accommodate Instead the government should make NHS capital the number of beds and other supporting services available – if need be as a long-term low-interest that would be required to deliver adequate care to mortgage – for the further upgrading of Epsom, and a such a large catchment population, and the financial new publicly-funded hospital to replace St Helier, and consequences for a health economy that is already local treatment centres to complement the services reeling under existing pressures would be disastrous. already available in smaller local hospitals. 3 Under PRESSURE would not be able to make savings of over £4m dur- A local health ing this financial year. As recently as September 2002 more than half (51%) of all St George’s 7,300 A&E economy in crisis patients waited longer than the government’s target 4-hour maximum, compared with 44% at Kingston, The South West London Strategic Health Authority, 25% at Mayday and 23% at Epsom & St Helier. which was launched in April 2002 after a merger of Kingston Hospital reported in January that its three former health authorities, oversees a budget of budget for agency nursing staff of £1.4m was already £1.2 billion to cover the health needs of 1.3 million overspent by £5 million, with the Trust as a whole residents. The NHS in the six SW London boroughs projecting a break-even position only as a result of employs 22,000 people. additional hand-outs totalling £1.9m from local PCTs By the autumn of 2002, just six months after it was and the StHA. The £3.9m of savings required during launched, SWLStHA was reporting combined debts 2002/3 had all been one-off measures, leaving an of £19.7 million, affecting the six hospital Trusts unresolved problem for next year, with a “minimum (£12.1m) in the area and the five Primary Care Trusts recurring financial deficit of 5%” on a budget of £130 (£7.6m). A major driving force in this economic insta- million. The Trust had got through the early winter bility has been the chronic problem of staffing, most “peak” of demand for emergency services only by notably among nurses and other professional staff. opening 31 additional beds to save patients having to London as a whole suffers from spend the night in A&E. major long-term problems in recruit- It seems as if there is more pressure to come, ing and retaining staff, exacerbated with additional tough targets for improved per- by the inadequate London weighting formance due to come into force in the next allowance, well short of the £6,000 a financial year, but insufficient new money to year plus free travel which has enable Trusts and PCTs to achieve the nec- helped stem the recruitment crisis of essary expansion. the Metropolitan police. A recent official NHS report A symptom of the pressure faced by local Trusts declared that the capital’s Trusts and PCTs spent a came when it was revealed in October that emer- thumping £446m on agency staff in 2001-2, half of it gency work at the specialist Pelvic Trauma Unit at St on nurses: but the situation has worsened, and the George’s hospital – the only unit of its type in London agency costs have soared even higher since those fig- – had been halted to make room for the treatment of ures were compiled. more waiting list patients. Trust bosses intervened to By the beginning of 2003, three of the four major insist that the treatment of pelvic trauma patients – hospital Trusts serving SW London were facing hefty mainly car crash victims – was bottom of the Trust’s deficits or wrestling with uncontrolled costs of agency priorities with beds so scarce.

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