EasterneyeA special campaign broadsheetpublished by UNISON EasternRegion health committee,November 2005 Free to members

The government is proposingchanges including the estab-lishment of a new StrategicHealth Authority to cover thewhole of Eastern England.

This will bring together NHSTrusts and Primary CareTrusts (PCTs) which currentlyface projected deficits totallingover £200 million, and areembroiled in cuts and closuresaffecting hundreds of hospitalbeds, a swathe of communityhospitals, vital services formental health and olderpatients, and upwards of 800health workers’ jobs.

The changes flow from theridiculously titled policy of“Commissioning a Patient-ledNHS” – a policy that was only

unveiled in a circular to healthservice managers from NHSChief Executive Nigel Crisp onJuly 28.

Crisp required proposals tobe drawn up and submitted bymid-October -- and so healthchiefs have been drawing upplans to merge the existingStrategic Health Authoritiesfor Norfolk, Suffolk, Cam-bridgeshire, Essex, Bedford-shire and Hertfordshire into asingle new “Eastern England”SHA.

In doing so, they have beenlistening neither to patientsnor to the general public, andthe proposals have come underwidespread criticism.

As part of the same process,

each county would also face around of mergers and reconfig-urations of Primary CareTrusts.

In the six counties of EasternEngland several PCTs are deepin debt, and at least 18 PCTsout of the present 41 currentlyface deficits in excess of £1million by the end of thisfinancial year, with a com-bined cash gap of over £100million. Several of the region’slargest hospital Trusts also facehefty deficits which are forcingthrough cuts in beds and serv-ices, and job losses.

As commissioners of thebroad range of NHS services,and providers of many servicesto the most vulnerable sections

of the population, PCTs havelittle scope to cut spendingwithout having an impact onpatient care.

They are also under pressureto ensure that certain govern-ment targets are met, and mostof these targets revolve aroundthe most visible acute hospitalservices (waiting times, time tobe treated in A&E, outpatientappointment waiting times,etc): this seems to be whymany of the cutbacks that havebeen announced have focusedon less politically sensitiveareas – often affecting morevulnerable and less vocalgroups of patients, such as careof the elderly, and mentalhealth.

Nevertheless there have beenangry meetings, marches andprotests against a number ofthe cutbacks that have beenproposed, most notably againstthe cuts and closures in com-munity hospitals in Suffolk(Newmarket, Felixstowe, Sud-bury, Hartismere, Aldeburgh,and in Stamford (which is justover the border in Lin-colnshire, but the hospital isrun by the cash-strappedPeterborough Hospitals Foun-dation Trust).

In Cambridge campaignershave protested at the heavy-handed cuts in mental healthcare; in other areas the fullimpact of the cash squeeze hasnot yet been revealed.

Hewitt’s £200mheadache forEastern England

INSIDESuffolkpunched!Massive cutsrock healthservices in Eastand WestSuffolk

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PrimaryCareTrustsWhat do theydo? Are theybeingfattened upforprivatisation?

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WHEREhas alltheMONEYgone?We probebehind thecuts and cashcrisisPPAAGGEE 22

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This special newspaper is published by UNISON EasternRegion, which covers all of the six counties of EasternEngland.

It looks at the underlying pressures on NHS budgets thatare driving the mergers, cuts and job losses, and then look inmore detail at the issues arising in each of the counties, asthey affect health care staff, patients, carers, and the widerpublic.

Removing directly-provided services – and the managementbudget that goes with them – from PCTs will generate onlythe illusion of savings and efficiencies.

In practice a new range of private, voluntary or devolvedNHS providers would need to emerge, each of which wouldneed to be managed, monitored and resourced – while thereis a real danger that some current PCT services will slipthrough the cracks of the reorganisation and cease to be avail-able to local people who need them.

A look at the extra resources that have been made availableto Trusts and PCTs, and the additional targets, cost pressuresand responsibilities that have gone with them, shows that theroot cause of the cash crises in Eastern England and manyother parts of the NHS is not waste or incompetence butinsufficient funding to cover all of the ambitious targets theyhave been set.

The government has willed the ends – a modernised,improved NHS – but not sufficiently provided the means forlocal Trusts and PCTs to deliver.

In many cases today’s cash problems are recurrent deficitsthat are the product of years of underfunding, and could beresolved with a one-off cash injection to balance the booksand lay a solid basis for future services.

We urge local councillors, MPs and NHS organisations tojoin with us and the campaigners already fighting for thispolicy, and to press Patricia Hewitt for a change of directionto preserve and improve our local services rather than under-mine them.

UNISON’s responseUNISON is opposed to the government’s requirement thatthe huge deficits that have arisen must be paid back intwo years: cutbacks on this scale would devastate servicesand lead to massive loss of jobs across the board.

Nor do we accept the short-sighted, largely cash-driven pro-posals to close the community hospitals that have been a keyfeature of health care in much of Suffolk: the strong and pop-ular local campaigns in defence of these hospitals show thatthese policies are not patient-led, while it is clear that thePCTs involved have no serious plans, and little in the way oftangible resources to replace the services they are proposingto close.

Our starting point is that we need to ensure that front-lineservices are maintained.

All the evidence to date shows that these are most effi-ciently, effectively and fairly provided by the NHS itself – as apublic service, and as the only organisation with the expertiseand proven ability to deliver the full range of services to localcommunities.

The NHS workforce is therefore an asset in securing thelong-term future of health care services, and not an overheadexpense to be cut back in the quest for short-term savings.

We are especially concerned that even those plans for costefficiencies which have avoided making staff redundant haveoften deleted posts, creating the contradiction of newly-quali-fied nursing, medical and professional staff left without jobsto go to, while Trust managers scour the world on expensiveexpeditions seeking to recruit overseas doctors and nurses.

And UNISON is very strongly opposed to the notion thatPCT services – or any other health care services – could bein any way ‘improved’ through privatisation or outsourcing tothe voluntary sector.

UNISON does not believe that either the private or volun-tary sector has sufficient expertise or resources to deliver thistype of services to all who need them, let alone on the scalerequired.

At a time when PCT budgets are already stretched to break-ing point, it is clear that any policy which slices off an addi-tional share of NHS funding to finance the profits of externalproviders will simply serve further to undermine patient care,and leave more vulnerable people without the support theyneed.

RegionalviewGEOFF REASON, UNISONEastern Region

captionhere

Government targets to improveperformance and reduce wait-ing times, most of which havebeen successfully delivered,have all come at a cost ofincreased spending.

Numbers of NHS staff haveincreased – with substantiallymore nursing staff, doctors andother clinical staff in post.

Even acute bed numbers haveincreased, after ministers recog-nised that the cutbacks of the1980s and 1990s had gone toofar to allow hospitals to copewith peaks of demand.

To make matters worse, theconstant reorganisation – thecurrent shake-up is the fifthmajor change since 1997 – con-sumes management time andresources, and confuses anddemoralises staff.

The preparation for the new,competitive system of “paymentby results” next April will furtherincrease administrative costs forTrusts, and leave some sectionsof NHS departments under-usedand less efficient.

The NHS Confederation pointsout that the years running up toLabour’s big investment in theNHS had seen “very tight finan-cial settlements” through muchof the 1980s and 1990s, withGordon Brown also continuing toapply Tory cash limits on theNHS until 2001. It concludesthat:

“The cumulative under-spendbetween 1972 and 1998 hasbeen calculated as £220 billion

in 1998 prices. Relative to EUaverage spending on an income-weighted basis, the cumulativeunder-spend is £267 billion.”

This goes a long way toexplaining the shortage of manytypes of staff, the poor conditionof many buildings and the lowlevel of investment in equip-ment.

A culture developed in whichNHS organisations wereexpected to report that they had‘broken even’ without anyenquiry into whether the meth-ods used were sustainable.”

This same culture led for many

years to a practice of usingmoney taken from capital budg-ets, supposed to be used tomaintain and improve buildingsand equipment, to bail outdeficits in Trust’s revenueaccounts – another short-termfix that fails to offer sustainableservices.

Last year Gordon Brown andthe Treasury stepped in to stopthis happening, and the level ofTrust deficits rose sharply.

Some of these were concealedby the operation of the NHSBank, which uses the surplusesfrom some of the better-

resourced NHS Trusts and PCTsto lend money on a short-termbasis to those in deficit: it has tobe repaid the following year,leaving the borrowing Trust witha much larger financial problemto resolve.

From this year all such bor-rowing will carry a penalty inthe form of a 10 percent interestpayment – as part of the effortto persuade the best resourcedTrusts and PCTs to live withintheir means – and actuallyspend less than their allocation,delivering less care for theirown patients.

A recent report, Money in theNHS: the facts by the NHSConfederation, the body repre-senting NHS Trusts and PCTs,investigated how the addi-tional money invested in theNHS budget since 2002 hasbeen spent.

It noted:average annual increases

of 7.4 percent in real termseach year since 2002, whichare due to continue until2007/8, equivalent to a 43percent total increase in realterms.

In 2004/5 almost threequarters (73 percent) of theadditional money was allo-cated to services that hadbeen “chronically under-funded”.

This included “30 percentspent on employing new staffand 20 percent spent onincreasing pay”.

This includes the costs of newcontracts for consultants andGPs, as well as the costs of therestructuring of pay more gen-erally under Agenda for Change:the NHS has also faced bigincreases in medical staff costsas a result of the Working TimeDirective.

Other costs in this categoryincluded drugs, building repairsand improvements and newtechnology: inflation in all of

these areas has run at a muchhigher level than inflation in thewider economy.

20 percent of the extramoney was spent on providingadditional services.

The remainder, a massive7 percent of the “new money”,was not actually paid out inmoney at all, but assumed tobe generated through effi-ciency improvements.

Drug costs increased bothbecause more prescriptionswere issued (up almost 6 per-cent in 12 months) andbecause the cost of the itemsrose even faster (spending onprescription medicines hasincreased by 46 percent since

2000 to £8 billion nationally),creating many pressures onlocal prescribing budgets andon hospital pharmacies.

A massive 29 percent ofthe additional funding in2004/5 was spent on pen-sions, because the Treasuryhad passed over the cost ofinflation-proofing the NHSpension to the Department ofHealth.

And across the countryaround 60 NHS Trusts are nowforking out inflated paymentsfor new buildings fundedthrough the Private FinanceInitiative, which are soakingup 11 percent or more of theirincome.

Where has all themoney gone?

The soaring cost of meetingwaiting list and other targets

Do youhave apicture?

The government set up Pri-mary Care Trusts (PCTs) inEngland in 2001 to bringtogether all the NHS ‘depart-ments’ that provided care out-side hospitals.

PCTs are responsible for GPs,dentists, opticians, local phar-macies, district and schoolnurses, health visitors, othercommunity services – and as“commissioners” of care, theyare also responsible for pay-ments for all hospital servicesused by their residents.

However in a dramatic, sud-den and unexpected announce-ment in July this year PCTs areto be enlarged and stripped oftheir role in providing healthcare: they are to become com-missioners of care only: inOxfordshire the proposals goeven further, with plans to pri-vatise the commissioning func-tion of the PCT – potentiallyhanding control of budgetstotalling £575 million to a pri-vate company.

Government policy has for awhile been to transfer as muchwork as possible from hospitalsinto GP surgeries and ‘thecommunity’.

This is thought to be whatpatients want, will help toreduce the demand in hospitalsand A&E departments, and be‘cost efficient’ – i.e. cheaper.

But as services are transferredfrom hospitals to the commu-nity it is rarely possible toidentify the shift of resourcesto pay for the service in its newsetting.

In spite of the increase inNHS funding, many hospitalsand PCTs are short of cash anddesperately trying to savemoney.

Already care for asthma,blood pressure and diabetestakes place mainly within gen-eral practice, and the aim is toprovide care in hospital onlyfor patients who must receivethis ‘specialist’ level of care.

In other words the servicesthat PCTs now provide are tobe further increased at thesame time as PCTs are to beforbidden to provide themthemselves after 2008.

The nature and status of thenew providing bodies is cur-rently (end October 2005) amystery.

The assumption is that this isa huge opportunity for the pri-vate sector to take a big biteinto the NHS outside of hospi-tals, and the policy has beenopposed by this year’s TUC,Labour Party Conference, andalmost all organisations repre-senting health workers, includ-ing UNISON.

While the mergers are arguedto represent a reduction inoverhead costs and manage-

ment expenses, and in somecases reunite services that werecontroversially split up a fewyears ago, it seems that oneunderlying factor in the merg-ers is to “fatten up” the PCTs’directly provided services, tomake them large enough tointerest potential private com-panies.

The six Eastern Englandcounties face a reduction from41 PCTs (17 in Norfolk, Suf-folk and Cambridgeshire, 13 in

Essex and 11 in Bedfordshire& Hertfordshire, to as few as 7or a maximum of 11 (3 in NSC,2 in Essex and 2-6 in B&H).

Among the losers are thePCTs covering the new unitaryauthorities of Peterboroughand Luton, which face beingrolled back into a county-widestructure that was long seen asfailing to address the specificneeds of these centres of popu-lation.

Critics of the mergers and

reorganisation point out that itwill break up local links andnetworks that have just beenestablished, and break any ele-mentary development ofaccountability to local popula-tions as PCTs become remote,country-wide structures.

The SHAs too will becomeeven more remote regional-type organisations with little ifany link with the various com-munities and populations theyare supposed to serve.

Primary Care Trusts

Fattened upby mergers,carved up byprivate sector?

Campaigners in Oxfordshire are battling against plans to privatise the commissioning role of anew merged Oxfordshire PCT, handing a budget of £575m a year to a private company, whichwould take charge of purchasing health care for a county-wide population of 625,000

Eastern Englandcounties currentlyhave 41 PCTs

1177 in Norfolk,Suffolk andCambridgeshire,

1133 in Essex and

1111 in Bedfordshire& Hertfordshire,

This could fall to asfew as 7, or amaximum of 11

33 in NSC,

22 in Essex

and 22-66 in B&H

Throughout much of the lastfinancial year it was clear thatTrusts and PCTs were runningup large and unbridgeabledeficits.

But this was the run-in towardsthe 2005 General Election, andthere was clearly an indicationthat Trust bosses should avoidmaking large scale cuts and clo-sures to balance their books inthis sensitive period.

Much larger debts than usualwere rolled over into the currentfinancial year, and this is thebackground to the cash crisis wehave identified in EasternRegion.

Sometimes local Trusts andPCTs explain the impact of thesituation openly: more often theyrevert to the traditional cultureof pretending they have brokeneven – or are about to do so.

We can see some of the resultsof ‘hoping for the best’ in theNorfolk Suffolk and Cam-bridgeshire SHA (NSC), whichlast year projected an overall netdeficit of £43 million, only to dis-cover after external auditors

came in that the real deficit was£68m – the largest discrepancyof its kind of any SHA.

By August this year the situa-tion in NSC had deterioratedeven further, with a forecastoverspend across the SHA risingto £92 million – almost £50mabove the target figure set withindividual Trusts and PCTs by theDepartment of Health, and £16mworse than forecast in the LocalDevelopment Plan.

Even then, the projected sav-ings, many of which had notbegun to show any success, fellway short of the target figure.

Now in Suffolk, the IpswichHospital Trust, despite operatingcosts running at 9 percent belowthe national average (putting itin the top 15 percent of efficienthospitals) – and despite hittingall the key national targets for

performance – faces a risingtide of emergency admissions(which outnumber waiting listadmissions more than three toone) and a deficit which hasremained unresolved since2003/4.

Among the factors that com-pounded the Trust’s financialproblems last year have beenthe soaring costs of InformationTechnology, the implementationof Agenda for Change,“unfunded activity” and“reduced access to communityservices”, resulting in patientsstaying longer than medicallynecessary in front-line hospitalbeds.

But measures to reduce theuse of emergency beds have notdelivered the promised results,either. Ipswich’s most recentAnnual Report (2004/5) con-

cludes:“It is imperative that we con-

tinue to work with our local Pri-mary Care Trusts to address theunderlying financial problem,and in seeking to minimise theincrease in emergency activityas far as possible.”

The Trust notes that because ofits low operating costs it is one

of those expected to derive extraincome from the Payment byResults system when it is intro-duced next year. However thedifficulty is that the Trust’spotential increased incomedepends upon the PCTs’ abilityto pay, and even the most opti-mistic view shows the SuffolkPCTs facing deficits of £36m.

Ignoring crisis did notmake it go away

There are fears that the strug-gling West Suffolk Hospital inBury St Edmunds, facing a£20m deficit, could be mergedwith Addenbrooke’s Hospitalin Cambridge, 37 miles away(Cambridge Evening News 13August). The Trust is expect-ing to overshoot its target of a£7 million overspend, notch-ing up another deficit pro-jected at £11.3m by the end ofthe year.

Plans to axe hospital serviceswith the closure of all 16 bedsand a day hospital at Newmar-ket Hospital to save £1m havebeen met with protests (Cam-bridge Evening News 3 August).

There have also beenmarches and campaigns to pre-vent the closure of WalnuttreeHospital in Sudbury, which isonce again under the axe in thequest for savings, as is StLeonard’s in Sudbury.

The strategy of the SuffolkWest PCTs is mapped out in aconsultation document Mod-ernising Healthcare in WestSuffolk, which is replete withreferences to the phrase “carecloser to people’s own homes”– which in practice appears tomean care IN people’s ownhomes, preferably provided –if at all – and paid for byorganisations other than theNHS.

The PCTs point the finger ofblame for part of the currentfinancial squeeze at the £10mdeficit inherited from the for-mer Suffolk Health Authoritywhen PCTs were first estab-lished in 2001.

But as in east Suffolk, PCTsare also very keen to “reducethe number of people who areinappropriately cared for inhospital”, even while notingthe fact that numbers of emer-gency admissions to hospitalhave continued to increasedespite previous promises andplans to the contrary.

Modernising Health Care pro-poses:

Closing 55 beds at WestSuffolk Hospital “30 of whichare designated for rehabilita-tion, care of older people andpeople with medical condi-tions” – almost 50 percent ofthese beds in the Trust.

This follows the closure of 33rehabilitation beds in 2004,and comes in the context ofemergency admissionsincreasing by 8.2 percent overthe last two years.

Closing 48 communityhospital beds at Newmarketand Sudbury

West Suffolk Hospital Trust,which has also had to close twotheatres and axe 220 jobs in itsefforts to break even, now facesa penalty charge of 10 percent– £1m – on the borrowing itwill need to pay bills and sur-vive to the end of the financialyear.

The West Suffolk PCTs gofurther than most other cutspackages in trying to arguethat the changes – which havetriggered angry protests – aresomehow responding to thedemands of patients and thewider public:

“The public tell us that weneed to coordinate our servicesbetter with Social Care so peo-ple do not need to spendunnecessary time in hospital.

“Statistics tell us that manyolder people find themselvesin a hospital bed because alter-native provision in the com-munity is not readily avail-able.” (p6)

The proposal that has won solittle public support is to close

hospital beds and “replacethem” with “better intermedi-ate care services” – on theassumption that this will besufficient to avert a large pro-portion of hospital admis-sions: the community hospi-tals would then be “mod-ernised” … by closing themdown and selling them off, todeliver “an overall saving of£2.7m in a full year”.

A new “health and social carecentre”, effectively a healthcentre with a nursing homeattached, and containing noNHS beds, is promised forSudbury – although this is stillat the planning stage andwould be built – if at all – wellafter the closure and sale ofWalnuttree and St LeonardsHospitals.

The PCT has still not evenworked out how some vitalservices such as phlebotomywould be provided in Sudburyduring the limbo period inwhich the hospitals have gonebut their replacement has notopened.

Maybe, like specialist clinicscurrently delivered in Sudburyby teams from West SuffolkHospital, they would simplybe scrapped – obliging patientsto travel themselves to Bury StEdmunds to get the servicesthey need, with round tripjourneys taking as much as sixhours.

Newmarket, too, would see a“redesign” of its CommunityHospital to exclude any in-patient services, again scalingit down to a health centre: 62staff have been issued with

official notification that theycould be made redundant, andup to 90 jobs could be at riskfrom the various closures inNewmarket.

Thetford Cottage Hospitalhas also seen its outpatientclinics cancelled by the WestSuffolk Hospital Trust as itmoves to recentralise services,leaving patients longer jour-neys for treatment.

PCT chiefs have complainedat the poor turnout at theirroadshow ‘consultation’ meet-ings seeking to sell the cutspackage to local people: butthis is hostility and cynicismtowards the charade of consul-tation rather than apathy.

In Newmarket for example,over 200 angry people packedthe town’s Memorial Hall toback the campaign against theclosure – while just nine hadturned up to the PCT’s “con-sultation” in the same hall.

In Sudbury over 400 peopleturned out to link arms aroundWalnuttree Hospital in Sep-tember, and local GPs havevocally joined the campaign toresist the PCT proposals,warning that terminally illpatients, stroke victims, theelderly and the very youngwould be the main victims ifthe Hospital were to close.

The repeated angry cam-paigns that have continued toresist these proposals make itvery clear that they are neitherpopular nor patient-led.

As if to underline the lack ofpublic confidence that thepromised “intermediate care”would be able to deliver ade-quate support to patients intheir own homes, the PCTs arealso proposing to reduce out ofhours GP services to littlemore than a ‘call centre’ phoneline.

And other aspects of thecommunity health services arealso to face cuts and “moderni-sation”, including:

The wheelchair service School nursing Health visiting Podiatry Speech and Language

Therapy Counselling Reproductive Health

Suffolk West PCT is alsolooking to make cuts in out ofarea referrals, force down theprices they pay hospitals out-side the area, and cut back onnon-clinical support services.

SuffopuncTrust and PCT managers have beenissued with directives from theDepartment of Health that financialbalance must now be among their topseven priorities: as the Suffolk East PCTsStrategic Board was told in July:

“All organisations must deliver the top7 national priorities on time in full whilstachieving financial balance.

The top priorities are:

Achieve A and E performance targets

Achieve patient access / waitingtimes

Achieve cancer access targets

Implement Choose and Book

Deliver on cleaner hospitals andMRSA

Implement Agenda for Change

Achieve financial balance”

The East Suffolk PCTs concluded, as theydrew up a list of cuts, that:

“Over 75% of the PCTs expenditure isoutside of its direct control and isprincipally spent through commissionedactivity either through GPs, acuteproviders or other third party/ voluntaryproviders.

“70% of the total healthcare spendrelates to staff/workforce.

“Recovery to a sustainable level ofspend must therefore mean less activity,less staff, less facilities and consequentlya reduction in current levels of service ora change in current models of service.”

Over 200 beds in Suffolk face closure,including 55 at West Suffolk Hospital.Health Secretary Patricia Hewitt hasbrushed off appeals from localcampaigners for her to intervene andhalt the round of cuts and closures thatthreaten services across the county. Yeteven the most optimistic figures showTrusts and PCTs in Suffolk facingprojected deficits of £53m this year.

Mental healthcare under threatWest Suffolk PCTs argue the need for a £6.85 million cut inspending on mental health and learning disability servicesacross the county as a whole, and explain that longer-termplans that were to have been undertaken over a number ofyears are being rushed through now in order to meet thesefinancial targets (p11).

The consultation document therefore proposes a series ofstraightforward cuts with little pretence that any serious replace-ment services will be offered to service users:

Close the Sage Day Hospital for Older People’s Mental Healthin Newmarket

Close the Talbot Unit, a small day centre for dementia sufferersin Sudbury, which is currently part of the doomed Walnuttree hospi-tal.

Close the Heathfields adult respite and day care centre in New-market, which offers 23 places for people with complex needs.

West Suffolk countsthe cost of latest cuts

olkched!

600 people backed a Julyprotest march through Felixs-towe to fight any plans for clo-sure of the Bartlet Hospital,one of the two local hospitals.

Hartismere Hospital in Eye,which has also been supportedby a substantial demonstra-tion, is also set to close nextspring after a decision by Cen-tral Suffolk PCT.

East Suffolk’s PCTs had orig-inally hoped to scoop up a £6mwindfall by selling off the Bart-let and Hartismere hospitalsites, in addition to the rev-enue savings from scrappingservices there and at Alde-burgh, with “significantredundancies”: but it hasbecome clear that any capitalgenerated by the asset-strip-ping sale would be funneledinto a national Department ofHealth kitty, with only smallshare eventually coming backto Suffolk.

Meanwhile a thinly-popu-lated area with poor publictransport links could face theloss of existing health care butmiss out on any proper com-munity-based services to takethe place of the closed hospi-tals.

The closures would almostinevitably precede the estab-lishment of the promised serv-ices, even if sufficient staffcould be recruited and trained.

For many vulnerable olderpatients left to fend for them-selves at home, the logical con-sequence will be that theywind up being admitted asemergencies to Ipswich Hospi-tal, compounding their prob-lems and occupying morecostly front-line beds.

In a policy for East Suffolklaughably entitled Changing forthe Better, PCT chiefs outlineplans (described as “moderni-sation”) not only to hack backon hospital care, bringing“care closer to people’shomes”, but also to save up to£3.2m in staffing and othercosts by reducing “avoidableadmissions” to acute hospitals,which are also closing beds.

The document makes clearthat a major underlying factorin the plans that are being pro-

posed is the cash crisis:“Most people will be aware of

the financial problems in thehealth service across Suffolk,and of the financial deficitswhich have built up in recentyears in most of our organisa-tions. … [p6]

“For Suffolk East this has alladded up to a very difficultfinancial situation. this finan-cial year the system has a com-bined financial deficit of£47.9m, most of which is in thePCTs. …” [p7]

“Unless we take steps to con-trol our current spending wewill overspend across thewhole system by £2,500 (£2,100for PCTs alone) every hour ofevery day. Our debts willincrease and add to an alreadyheavy financial debt. This isnot an acceptable or sustain-able position.

“… in this financial year wemust achieve recurrent balance(i.e. we must not overspend).Next financial year (2006/7) wemust sustain this position andpay off all of our accumulateddebt.” [p8]

“We have to acknowledgethat we can no longer afford toprovide some of our locallydeveloped services …” [p9]

In a misleading phrase thePCTs argue that they want to“change the way we use ourcommunity hospitals”: but itswiftly becomes clear that theydon’t want to change this butto close them down, and thatwhen they talk (p14) about “ashift in services away from theacute hospital setting to thecommunity”, they mean a shiftfrom hospital care to peoplebeing left to care for them-selves at home, with minimalpromises of NHS support.

That’s why they want to: Close all inpatient beds,

and then close and sell Har-tismere Hospital in Eye

Close the 20 beds, andthen close and sell the BartletHospital in Felixstowe

Slash the number of bedsat Aldeburgh Hospital, andhive off the entire inpatientservice there to an “alternativecommissioner”

Redesignate the beds in

the new 28-bed BluebirdLodge intermediate care centreto end their use as “step downbeds” facilitating dischargefrom Ipswich Hospital.

Close 52 beds and theHayward Day Hospital atIpswich Hospital

In addition to closing thehospitals, the FinancialRecovery Plan makes clear thatthe PCTs want to cut backspending on community serv-ices, with a “rationalisation ofpodiatry work”, consolidationonto fewer sites (creatinglonger journeys for patients),“stop doing low risk work”,and “service reduction to pop-ulation”.

Alongside these cuts in serv-ices and spending on olderpatients, Changing for the Bet-ter echoes the West Suffolkdocument ModernisingHealthcare in stressing theneed for a massive £6.85m cutin spending on mental health

and learning disability servicesacross the county.

The PCTs admit that:“part of the saving s target

arises out of the general finan-cial problems confronting theNHS as a whole.” [p21]

Among the cuts as a result,the PCTs propose to:

Close The Hollies, anemployment-based project inIpswich for mental health suf-ferers

Close two clubhouses, OldFox House in Stowmarket andBridge House in Ipswich,which provide community-based psychosocial day serv-ices for adult mental healthsufferers, which have offerededucation and training, advo-cacy services and social pro-grammes.

Close The Pines, an occu-pational therapy day servicefor mental health outpatients.

Close three of the four DayHospitals for older people’s

mental health, currently basedin Kesgrave, Minsmere, Sax-mundham and Violet Hill.

In addition to these clo-sures, the detailed plans forEast Suffolk also include slash-ing £800,000 from spending onout-of-area referrals for mentalhealth patients, (plus a further£1.3m from spending on men-tal Health/Learning Disability,by imposing reductions inservices and/or reductions inpayments to local Trusts andvoluntary sector).

Other cutbacks included inthe more detailed FinancialRecovery Plan for East Suffolkinclude

slashing £1 million fromspending on out-of-area refer-rals for children and peoplewith physical disabilities

Further cuts in children’sservices

the transfer or OralSurgery to GPs to save just£120,000 in a full year.

a reduction in Orthoticsoutpatient appointments(Orthotics aims to re-align thefoot and ankle bones to theirneutral position) (£75,000)

cuts in rheumatology andorthopaedic outpatients(£150,000)

“Outsourcing” 60 percentof audiology services(£250,000)

“Outsourcing” the com-munity equipment stores andwheelchair service

Transferring outpatient,follow-up and diagnostic teststo GPs “with special interest” –to save a massive £1.2 millionin a full year

Raising the thresholdrequired for hospital admis-sion to ensure “reduced butappropriate” elective activity –to save £2 million a year bytreating fewer people

“Further reduction ofacute activity through reviewof treatment thresholds”, sothat “patients will continue toreceive the care they need butwith a reduction in certainnon-critical areas” – to saveanother £1.2m a year.

Extended primary carecover in out of hours to reduceA&E “attendance and admis-sion” – to save £1.5 million ayear.

Slashing £500,000 fromthe patient transport contractwith East Anglian AmbulanceTrust.

Work with Ipswich Hospi-tals Trust “to identify furthersavings possibly through effi-ciency or further activityreduction” [i.e. treat evenfewer patients] – with a targetof saving £1 million this year.

The combination of cuts inboth community and acuteservices, and the severity of thecuts proposed for mentalhealth and learning disabilitymake it clear that the miseryfor Suffolk residents would notend with this spending round,but continue and grow foryears to come.

Ipswich Hospital is cutting34 beds and restricting the useof operating theatres in a bid tosqueeze down spending by amassive £11.6m in the currentfinancial year.

The Board had originally dis-cussed closing up to 80 medicaland surgical beds in 4 wards,but reduced the figure to 34after hearing of concerns fromstaff (East Anglia Daily Times15 August). The hospital hasseen patient numbers increaseby more than 6% over the lastfour years.

East Suffolkgets on themarchagainst cuts

Three of Norfolk’s PCTs arefacing deficits totalling £13million, although the great-est concern is focused onthe long-term implicationsof stripping PCTs of theirrole in directly deliveringlocal services.

Hundreds of jobs of front-line primary care and commu-nity-based staff are involved:they could find themselvesbundled off to anotheremployer yet to be identifiedor decided.

The wholesale restructuringof PCTs has also raised freshdoubts over the future of plansfor a new £25m hospital atCromer.

The main focus of financialproblems in the county hasbeen the centred on the northof the county, most notably theongoing cuts at the crisis-hitQueen Elizabeth HospitalTrust in King’s Lynn (QEH),wrestling with a substantialoverspend and recurrent finan-cial deficit; by month 3 of thecurrent financial year the Trustwas facing a deficit of £1.7m inplace of the planned surplus of£6.7m – a gap of £8.5m for theyear, suggesting that they willnot be able to repay any of thedeficit of £8.5m brought for-ward from last year.

Almost the whole QEHBoard has been replaced,including a temporary ChiefExecutive.

The problem is not one ofstaff, but inflation of non-paycosts and a failure to collect inthe full funding for treatmentof NHS patients. In the JulyBoard meeting members weretold that

“Underspends on staffingbudgets are covering over-spends on non-pay budgetsand under-recovery of income.This position is neither satis-factory nor sustainable …”

Three wards at QEH haveclosed, with the loss of 60 ofthe 508 adult and elderly carebeds. Theatre lists have beenreduced, with some jobs lostand staff redeployed, avoidingcompulsory redundancies.However there is a total freezeon recruitment to vacant posts,and management have talkedof privatising all ‘hotel’ serv-ices.

The Trust has embarked onan aggressive programme ofincome generation and asset-stripping, selling off nurses’accommodation, exploringextra retail outlets, and impos-ing car parking charges on staffand public.

Indeed plans to save moneyby cutting the number of out-patient follow-up appoint-ments have been complicatedby the knock on impact on the

likely reduction in numbersusing the hospital’s car parksand catering services.

Planned economies also callfor more rapid discharge of in-patients from hospital, push-ing the responsibility ontocommunity health, primarycare, nursing homes and socialservices.

One difficulty underlyingthis is “the lack of alternativecare options” that exist locally,which also drives a relativelyhigh level of hospitalisation inWest Norfolk.

With little flexibility in thewider system, and with localPCTs having failed to deliverany genuine way to supportpatients outside the hospital,QEH has resorted to planswhich assume a very high 95percent average occupancy of areduced number of beds,which the Trust describes as“extremely challenging”: butalthough the reconfigurationof wards will allow “a numberof posts” to be disestablished,the existing staff will be rede-ployed to other work withinthe Trust, and we are not toldhow this high intensity use ofbeds makes any serious contri-bution to cuts in spending.

The Trust is investigating“new models of intermediateor other care models” to facili-tate the earlier discharge ofpatients with more complex

conditions such as stroke ordementia, but by the AugustTrust Board this was still “notquantified yet”.

The Board is also investigat-ing ways in which non-opera-tive fractures could be treatedin community hospitals (Wis-bech or Swaffham) rather thanusing front-line acute beds.

The irony is that in theseproposed new models the QEHin Norfolk is hankering after

an expansion of communityhospitals and intermediatebeds which would allow themto hand over responsibility(and costs) to PCTs – the verymodel of care that is beingdemolished in Suffolk with theplanned closure of communitybeds and hospitals!

The Trust is also establishinga Rapid Assessment Team(RAT) which aims to avoid upto 200 admissions a year out ofthe 1,000 patients sent to QEHfrom nursing homes.

While the Trust claims that“20 percent of these patientscould continue to be managedin their home care setting”,they fail to explain who wouldmanage them, where the staffwould be found, and whowould pick up the bill.

The Trust concedes that:“Some concern has been

expressed by clinical staff andmembers of the public thatinsufficient intermediate careplaces of appropriate qualitycan be found in a short space oftime and/or that throughput ofpatients in community caremay slow down.

Since this seems definitely tobe the case, QEH has nowagreed an arrangementthrough which the Trust wouldbe compensated by West Nor-folk PCT for any patients whocannot be discharged for lackof appropriate alternative care

in the community.However financial pressures

are also beginning to emerge atthe Norfolk & Norwich Hospi-tal Trust, where the Board hasbeen warned in October thatunless action is taken a £2mdeficit could rise to almost£4m by the end of the year. Ahigher overspend of £5m hasbeen reported to UNISON.

Options to reduce costs andspending are limited at the£229m PFI-funded hospital,where most non-clinical sup-port services are included aspart of a legally-binding con-tract with the PFI consortium.

The £38m unitary charge theTrust pays to the consortiumeach year for 35 years is equiv-alent to a hefty 14 percent ofthe Trust’s revenue, and isadjusted every six months,with increased fees payable ifmore patients are treated.£25.5m of the charge is effec-tively “rent” for the privately-owned hospital, which sits onNHS land.

Now, as financial pressuresare mounting, the squeeze isinevitably being felt by clinicalservices.

One ward has closed,although under the guise ofredesignating it as a ‘decant-ing’ ward for other wards touse into while they are being‘refurbished’ (the obviousquestion is why a brand spank-

ing new flagship PFI hospitalshould already need all itswards ‘refurbished). Accord-ing to the Eastern Daily Press:

“While managers are promis-ing that cutbacks will notinclude job losses and willhave no immediate effects onpatient care, all divisionswithin the hospital have beenasked to identify potential sav-ings.” (October 20 2005)

The EDP goes on to quotethe Trust chair David Priorinsisting that:

“We will do everything possi-ble to break even.

“We cannot offer any guaran-tees but we are absolutelydetermined. … We are going tohave to stop doing lots ofthings we would like to dosuch as recruiting new staffand offering overtime.

“From Board level down wewill be keeping a tight rein onall outgoings and will comedown like a ton of bricks onanyone who does not keepwithin those constraints.”

Cutbacks are likely to centreon cutting bills for agency andlocum staff, after previousattempts to clamp down onthis have failed to meet targets.All vacant posts will bereviewed and “non-vital” postsfrozen.

Strong restrictions on the useof bank and agency staff arealso in force at the James PagetHospital, a first-wave Founda-tion Trust, which is reporting a£360,000 deficit as it attemptsto claw back a £4.1m shortfallfrom last year. £3.75m of sav-ings have already been identi-fied, to project coming even.These include cuts at JPH andknock-on effects at other localhospitals:

closure of one ward atJPH,

at Lowestoft Hospital oneward is transferring to JPHand the other two are merginginto one ‘area’ (with feweroverall beds) but supposedlyretaining separate identities

at Northgate Hospital inGreat Yarmouth one ward isclosing, with transfer of serviceto JPH.

There are no compulsoryredundancies, but a freeze onrecruitment and loss of nightduty and weekend canteenservices, and the FoundationTrust has started charging stafffor car parking.

As the Primary Care Trustsseek to balance their books,four of them – Norwich, NorthNorfolk, South Norfolk andBroadland – are contemplatinga revamp of their existingcatering services, switching toa cook chill system, with thepotential loss of 30 – 40 jobs.However no final decision hasbeen made.

PCTs and Trusts underpressure to slashspending and services

The irony is that inthese proposed newmodels the QEH inNorfolk is hankeringafter an expansion ofcommunity hospitalsand intermediatebeds which wouldallow them to handover responsibility(and costs) to PCTs –the very model ofcare that is beingdemolished inSuffolk with theplanned closure ofcommunity beds andhospitals!

This SHA has escaped reason-ably lightly from the financialchaos of its neighbours to thenorth and west, and has beensingled out by the Departmentof Health as one of the SHAsthat is required to deliver a netsurplus (under-spending theresources available to treatlocal people) in order to lendcash to over-spending Trustsand PCTs.

In fact the SHA recorded a netdeficit of £7m in 2004/5 andwas initially projecting a £39mshortfall for the current financialyear, over and above the out-standing debts which arealready due to be repaid by

Essex Rivers and PrincessAlexandra Trusts. the July SHAmeeting heard that:

“When the return of under-spends and brokerage are fac-tored in, the overall financialproblem facing the economy isin excess of £40m”.

However the Department ofHealth refused to accept theEssex plan and insisted that itrevisit its plans and deliver abalance this year.

However the projected deficitsat Princess Alexandra Hospitaland Mid Essex Hospitals wererecorded at £3.6m and £3.7mrespectively in July, whileChelmsford PCT was projecting

a shortfall of £14m andWitham Braintree andHalstead Care Trustwas facing a deficit ofjust under £8m.

By the time of theSeptember SHA Boardmeeting, heads of Trustand PCT bosses hadclearly been bangedtogether, but no explicit packageof spending cuts had beenrevealed: however the Mid EssexHospitals deficit had beenmiraculously eradicated, toshow a projected surplus of £1m– a turnaround of £4.7m, whilethe Princess Alex gap haddropped to £2.8m.

Chelmsford PCT had managedto squeeze the gap down to£11m, while Witham and Brain-tree had come down to £5.4m.

While the full results of thesecost cutting measures have yetto be seen, another threat loom-ing in the wings for Essex acuteTrusts is the Department ofHealth plan to commission a

new Independent Sec-tor Treatment Centreto cover Essex, with atarget of deliveringover 15,000 day caseand inpatient opera-tions a year, in generalsurgery, orthopaedicsand urology.

The target of 3,100in-patient jointreplacements to becommissioned from

the private sector will divert aminimum of £15 million in con-tract income from the county’sNHS orthopaedic departments: afurther 2,200 orthopaedic daycases will snatch another £1m.

Meanwhile NHS general sur-gery budgets will also face aloss of upwards of £5 million if2765 inpatient and 4700 day

case operations are diverted toa new private unit.

3162 urology day case opera-tions will also result in reducedbudgets for NHS hospital Trusts:in each case the private sectorwill accept on the least complex,most risk-free cases, leavingNHS units with reduced incomebut responsibility for the mostcostly and complex operations.

As UNISON has argued inopposing this government policyelsewhere, the total loss of morethan £20 million in revenue fromEssex NHS Trusts could be suffi-cient to undermine their desper-ate attempts to balance thebooks, and trigger a reduction inlocal services – resulting inLESS choice and longer journeysfor local patients needing someforms of treatment.

Essex

Norfolk hit by deficits

NHS Trusts stand to lose £20m a year toprivate treatment centre

The controversial new systemof Payment by Results is oneof the reasons why Cam-bridge City and South Cam-bridgeshire PCTs are runningenormous deficits.

They have already beenobliged to pay up extra millionsto the Cambridge UniversityHospitals Foundation Trust foradditional emergency and elec-tive admissions which had notbeen budgeted for.

Emergency admissions in thecurrent financial year havebeen running 18 percent aboveplan for South Cambridgeshire,and 12 percent above for Cam-bridge City, with electiveadmissions exceeding plan by5 percent and 13 percentrespectively.

An October 19 report to aJoint Board meeting of the twoPCTs on their growing cash gapnotes that:

“The financial positionreported for Addenbrooke’s isbased on the costed activityplan provided by the Trust. Itshould be noted that this planwhich applies payment byresults to most of the activitieswithin the scope of the hospitalis not affordable and formalagreement has not beenreached.”

While Addenbrooke’s hashoovered up additional patientsand staked its claim to a larger

share of the local commission-ing budget, it has taken thesepatients from other Trusts: itseems that one result is that in-patient activity at Hinching-brooke Hospital from the sametwo PCTs has fallen back by upto 25 percent.

The Joint Board PCTs meetingwas warned that, compoundedby the soaring bills at Adden-brooke’s, a serious shortfallwas looming up, in which somecreditors – or even staff – maywind up not being paid:

“PCTs cannot draw more cashthan their cash limit. Work iscurrently being undertaken toestablish the likely year-endshortfall. An early estimate ofthis suggests a shortfall of £20million.

The PCT will formulate a pay-ments policy which restrictscash payments by the amountof the predicted cash shortfalland this will be presented tothe November Board meetingfor approval.”

This vividly illustrates thebind facing Trusts and PCTs:whatever the combination ofexternal factors and cost pres-sures that have contributed tothe cash shortfall, at the end ofthe day there seems likely to bea decisive point at which cutsare to be made if the organisa-tion is not to run out of money topay staff and suppliers.

Addenbrooke’s Hospital, aFoundation trust, faces a£5m deficit and the dangerof bed cuts as a result ofthe cash crisis gripping itstwo local Primary CareTrusts, with a combinedoverspend of £19.5m thisyear.

The PCTs are reportedly over-spending by £9m a year onacute services, £4m a year onmental health and £1m a yearon primary care.

Addenbrooke’s has beencashing in extensively on theearlier implementation of“payment by results” for Foun-dation Trusts, driving up levelsof both emergency and non-emergency activity well aboveplanned (and affordable) lev-els, and sending the bill to thePCTs.

In October the joint meetingof South Cambs and Cam-bridge City PCTs warned thatthe excess costs if Adden-brooke’s activity continued atthat level would be £8.6mabove planned spending –while the two PCTs face a pro-jected shortfall of £23 millionfor the year.

Fearing that PCT budgetswould run out as early as Feb-ruary they called on Adden-brooke’s to slow the pace ofoperations, suspended IVFtreatment for childless couplesuntil next April to save an esti-mated £230,000 by delayinghelp for around 70 couples –and closed the 26-bedRupert Brooke rehabilitationward at Cambridge’s Brook-field Hospital.

Meanwhile Peterborough andStamford NHS FoundationTrust, another first-wave Foun-dation Trust, has emergeddeep in financial problems inthe aftermath of highly-publi-cised failures of a pioneeringFoundation Trust at Bradford.

Peterborough carried a hefty£7.7m deficit over from lastyear’s accounts, and has nowaxed 70 jobs and embarkedon a programme involving 106

bed closures, including threewards in Peterborough and award at Stamford Hospital.

Most of the jobs to be cutare nurses and health careassistants: a few admin sup-port staff will also be affected,although vacancies within theTrust meant that no redundan-cies were required (Peterbor-ough Evening Telegraph 24August).

The Stamford Hospital bedcuts triggered an angry 3,000-strong demonstration throughthe town in pouring rain. TheTrust has claimed that it doesnot intend to close the hospi-tal altogether, but insisted that

it cannot guarantee that thehalf-empty site will not closein the future. More than20,000 had signed the peti-tion against the ward closureby the end of September,demanding it be reopened.

Income generation at Peter-borough’s Edith Cavell Hospi-tal has meant that hospitalbased charities have beenturfed out of money-spinningstalls in the foyer to make wayfor commercial outlets.

The Greater PeterboroughPrimary Care Partnership,which holds the budget forproviding and commissioninghealth services in the unitary

authority, faces a £4.2m cashgap – and the possibility ofextinction if the PCT reorgani-sation collapses down thestructure to one PCT percounty.

GPPCT carried over a £1.4mdeficit from last year, but hasfaced additional pressures thisyear and is not in “a very frag-ile position” according todeputy chief executive AngelaBarr. They have imposed avacancy freeze, with somejobs to be left permanentlyunfilled – and, with morale atrock bottom, saved somemoney by scrapping this year’sstaff survey.

There has been a reduction infunding of £3 million by thePrimary Care Trust, who blameit on a lack of governmentfunding. The Cambridgeshireand Peterborough MentalHealth Partnership along withthe local PCT is proposingmassive cuts in Mental Healthprovision for Cambridgewhich will lead to a reductionin approximately 120 full timeposts.

Alongside this the local Men-tal Health Trust is looking atways to reduce expenditure bya further £4 million through-out Cambridgeshire and Peter-borough. This means that serv-ices throughout Cam-bridgeshire and Peterboroughwill be reduced, closed orcease. So the care provided andthe associated jobs will disap-pear.

The permanent closure ofNo 1 The Drive and the Gate-house (A service for peoplewith enduring mental healthproblems) would axe rehabili-tation services.

The closure of the Cedars(a facility for people withenduring mental health prob-lems) would cut rehabilitationand also reduce any possibilityrespite care for community-based clients and their carers.

The attack on rehabilita-tion services continues withthe planned closure of the spe-cialist community team inCambridge, and the adult com-munity mental health service,including its weekend servicewould be collapsed into a newCrisis Resolution Home Treat-ment Service.

The needs of the Commu-nity Psychiatric RehabilitationServices Community MentalHealth Team (CPRS/CMHT)patients would be “reviewed”and patients transferred toeither the Assertive OutreachService or the CMHTs.

The CPRS MHT would beintegrated into either existingCMHTs or the Assertive Out-reach Team by September2006.

This is a massive dislocationof an established team and careto people with enduring men-tal health problems.

The proposed closure of a22-bed acute ward at Fulbournor Addenbrooke’s would axeover 20 percent of the Partner-ship Trust’s adult inpatientbeds.

A quarter of the beds forolder people would also beclosed down, with a limited

amount of the money to beused to expand the older peo-ple’s CMHTs to operate 7 daysper week, but with an overallloss of jobs.

The Cambridge Day Cen-tre (CDC) would close imme-diately after formal close ofconsultation. Patients willtransfer to alternative day carefacilities provided by the Trust.

Some remodelling of theremaining day services will berequired to create capacity forcurrent users of CDC who willcontinue to need day services.Older People’s Day Serviceswill also bee reduced fromApril 2006.

Arts therapies would beheavily cut back with loss ofjobs and staff integrated intoother clinical teams.

The combined package isdesigned to save £3m – at theexpense of substantial reduc-tions in care.

The Young Person Ser-vices Day Programme wouldbe scrapped, as they say it is nolonger viable

The Dementia Drug Ser-vice would close, with the lossof the associated post.

Money for Child and Ado-lescent Services has been with-drawn already.

While many of the cuts are

concentrated in South Cam-bridgeshire and CambridgeCity, there is an unresolvedpressure on East Cam-bridgeshire and Fenland PCT,which has been balancing itsbooks through a succession ofone-off measures, but pointsout that “this level of non-recurrent savings is not sus-tainable”, faces a recurrentoverspend of £10.8m this year(PCT Board May 2005).

The closure of the 28-bedIceni Unit at Doddington Hos-pital will axe excellent facili-ties for care of older patientsfrom the end of October, withthe nearest centres being thePrincess of Wales Hospital inEly, or the North Cambs Hos-pital in Wisbech.

And the closure of Alan Con-way Court in Doddington willbring the loss of 16 beds forolder patients with mentalhealth problems, leaving thenearest equivalent services inWisbech.

Once again the PCT is claim-ing to replace hospital bedsclose to patients’ homes withcommunity services allegedly“closer to home”.

The cutback is designed tosave £300,000 towards thedeficit of Peterborough MentalHealth Partnership Trust.

Cambridge targets mental health care

Cash crisis disturbsthe Foundations

PCTs can’t affordto pay by results!Cambridgeshire cuts back

3,000Protestors

bravepouring rain

to marchthrough

Stamford inopposition to

ward closuresand the

threat thatthe whole

hospitalcould close.

The Bedfordshire & Hertford-shire Strategic Health Author-ity is unusual in the region,with no organisations forecast-ing a surplus for surplus in2005/6, and three hospitalTrusts facing deficits in excessof £12 million. The situation,according to the June Boardpapers is

“not unique, with 16 otherSHAs being unable to preparefinancially balanced plans. How-ever only 4 SHAs have reporteda projected 2005/6 deficit inexcess of £70 million.”

Luton Primary Care Trust iswrestling with a £6 m over-spend, although so far theresponse has been only the pro-posed loss of 8 jobs, – includ-ing 2 G.P.posts.

BedfordshireHeartlands Pri-mary CareTrust faces a£14.4m over-spend, ofwhich £6m isrecurrent rais-ing the possi-bility of a£20m gap bythe end of thefinancial year.It has pub-lished plans toclose three Dayhospitals for‘Older peoplewith organicmental healthconditions’

Farley Hill,Luton

The Lawns,Biggleswade

Sheridan, BedfordThe suggestion is that the

services could be provided bySocial Services, with support forclients from Community Mental

Health Team, but the bottom lineis yet another attack on mentalhealth services in the region.

Hospitals across the SHA arereeling under pressure from a 3percent increase in referralsfrom GPs, compared with aplanned reduction of 3 percent.

Despite this Trusts appear tobe meeting the target of a 9 per-cent cut in acute beds acrossthe SHA: the associated savingson staff (initially be reducingnumbers of agency and bankstaff used to fill vacant posts)are only just beginning to takeeffect.

Bedford Hospital, facing a pro-jected deficit of over £12m thisyear, has closed two wards, andcut 10 theatre sessions per

week.Luton & Dunstable Hospital in

mid October imposed a freezeon all job vacancies as itshowed signs of running into itsfirst deficit for seven years.

Bedfordshire

Hertfordshire

Watford & Three Rivers andDacorum PCTs carried over a£9m deficit from 2004/5 andhave opted to defer anyattempt to clear the debts untilnext year. St Albans & Harp-enden and Hertsmere PCTsalso carried forward debts, andnow face a £5m spending gap.

The performance on waitingtimes of Trusts in the SHA isalso seriously out of line withgovernment targets, withnumbers waiting over sixmonths running at 62 percentabove the target in April 2005in 8 of the 11 PCTs and overdouble government targets inWest Herts Hospitals Trust.

These figures will no doubtbe exploited as justification forthe moves to establish two newprivately-run “Surgicentres”to take over a share of the leastcomplicated elective surgeryfrom NHS hospitals, with afull Business Case to be signedby April 2006.

Six companies have appar-ently expressed an interest inbidding for the contracts,which are funded centrally bythe government, but wouldswitch up to 15,000 operations– and the funding for them –away from local NHS Trusts

and funnel itinstead into private compa-nies.

The long-term impact of thiscould be to undermine the via-bility of some specialistdepartments in existing NHShospitals.

So far there have been 3 wardclosures (90 beds) at WestHerts Hospitals Trust, whichfinished last year with a £13mdeficit, and is projecting ashortfall of almost £24m by theend of this financial year.

50 of the beds closed are atWatford General – but no cost-ings have been given on howmuch the ward closures areintended to save.

There have been repeatedrumours of plans to close thebirthing unit at Hemel Hemp-stead, and changes to emer-gency services, punctuated bymanagement denials .

Watford and Three RiversPCT has also decided to slash£900,000 from the HospitalTrust’s contract and switch itto primary care services, with asuggestion that some GPsmight try their hand at minorsurgery.

However the Trust is cur-rently consulting on staffing

savings – i.e. freezing of posts,a halt to the use of agency andbank staff, and potentialredundancies.

In mid-October major planswere unveiled to cut services atthe Trust’s St Albans City Hos-pital, cutting clinics, closingthe pharmacy, transferringgynaecology to Watford Gen-eral and moving radiology andimaging services to HemelHempstead.

The desperation to balancethe Trust’s finances will beincreased by the drive to find aprivate consortium willing toput up the cash for a new PFIhospital.

Meanwhile the long-awaitedplans to slash spending in thefinancially-challenged East &North Hertfordshire HospitalsTrust have been published inOctober, with the closure ofmaternity and major surgery atWelwyn Garden City’s QE2Hospital, with these and allemergency ambulance servicesbeing diverted to the ListerHospital in Stevenage.

Trust bosses hope to save amassive £49 million by 2008-9

by effectively downgrading theQE2 to a treatment centredelivering most elective opera-tions together with emergencymedicine.

It would retain a paediatricdepartment and a limitedcapacity A&E that would nottake blue light ambulances,but it would not offer mater-nity services.

Jobs would be lost at theQE2, but it is expected thatthis could be achieved throughnot renewing short term con-tracts.

The Trust has resorted to thedesperate tactic of seeking to“outsource” medical secre-taries’ work to India in a bid tocut costs, with the threat thatit could herald redundanciesamong the 150 secretariesworking in the Trust if thepilot study proves successful.

City whiz-kids PriceWater-houseCooper had previouslysuggested a doubling of secre-taries’ workload, with just onesecretary to support four con-sultants instead of the presenttwo.

Deep cutsbite intoHeartlands

Cash crisisforces A&Echanges

Here we goagain:

campaignsover the years

have struggledto defend

Hertfordshire’shospitals

against cutsand

rationalisation

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