Home - SR Editions - Socialist Resistance No.47

Manchester cuts highlight doubts over Darzi role

Harry Sloan

The announcement by Health Secretary Alan Johnson that he is rubber-stamping controversial closures of maternity and other hospital services in Greater Manchester has raised again a major question mark over the “review” of the NHS in England being carried out by new junior Health Minister Sir Ara Darzi. Darzi, a leading consultant and academic with something of a maverick reputation, was a shock ministerial appointment in Gordon Brown’s post-Blair reshuffle.

The appointment preceded by a week or two the publication of Darzi’s controversial report on reconfiguring London ’s NHS - the outlines of which must have been known to Brown before he offered him the job. He is only weeks into his review, yet the Manchester cutbacks already pre-empt a number of possible proposals for the North West , and fly in the teeth of very strong and popular local campaigns, at least one of which, in Salford , has involved Labour cabinet minister, then Party chair, Hazel Blears.

The Manchester cuts are just one of a series of plans for rationalisation of hospital services which are currently out to consultation in various parts of England : if they were all to be nodded through in the same way in the next few months, the Darzi “review” could be a superfluous exercise in locking the stable door after the horse has been put down.

Elsewhere there are concerns that Darzi’s activities may be little more than a smokescreen to divert attention from local level cuts pressed home under the pretext of “urgency” or “clinical need”.

In London , especially, Darzi’s plan is both contradictory and flawed: but unlike previous plans to rationalise hospital services in the capital it begins with a recognition of the need to remedy long-term and chronic inequalities in health and access to services in the capital, and also takes account of the whole of the capital and not simply inner London .

But what Darzi does not take account of is the financial crisis gripping many of London ’s hospital Trusts and Primary Care Trusts, which has been forcing them into a process of cutbacks involving “consultations” on unpopular closures.

In proposing a Londonwide plan for the allocation of health services, Darzi is in effect cutting across the fragmented and competitive “market” system that New Labour’s reforms have created. Nor is he explicitly plugging privatisation: all of the examples of good practice he singles out are from NHS, public sector hospitals.

However he has alarmed many by making vague proposals to replace London ’s existing network of busy district general hospitals with a combination of fewer, more specialised “major acute hospitals”, a handful of elite “hyper-acute” hospitals which would be equipped with enhanced systems to treat stroke victims, and another elite of teaching hospitals. This would leave far larger gaps between hospitals equipped to handle emergencies.

By implication DGHs that are not upgraded to one of these new specialist units would be effectively downgraded to lesser “local hospitals” or “elective units” - and this has raised questions over access to suitable Accident & Emergency services.

Darzi proposes to fill some of these gaps by establishing so-called “urgent care centres” which would deliver services for minor injuries, and by enhanced primary care, much of which he hopes would be located in a new network of 150 “Polyclinics” in which teams of up to 25 GPs would be based along with associated nursing and professional staff, becoming a hybrid of a massive health centre and a hospital outpatient department, with a combined budget of £3.1 billion per year.

Organisations representing London ’s GPs have already stridently denounced the plan for polyclinics, raising serious questions over whether they will ever get beyond the drawing board.

Even assuming such objections could be overcome, and the principle of such polyclinics (even if much smaller in scale and more local than Darzi’s suggestion of just five per London borough would imply) is accepted, whether or not the whole Darzi plan could work depends heavily on key details: how many of each type of hospital would be provided with how  many beds; where they would be located, and whether sufficient new investment would be available to allow the specialist hospitals to expand capacity to cater for the increased demand they would face.

None of this detail is to be found in the report.

A detailed report by campaign group London Health Emergency has pointed to worrying gaps in Darzi’s plans and numbers that do not add up convincingly - but also highlighted consultations that are about to begin and the services already being run down in at least five main areas of London .

In the South West the main threat is to A&E and services at Epsom General; in the South East, there are plans to rationalise the services of four hospitals - Lewisham, Bromley, Queen Elizabeth Woolwich and Queen Mary’s Sidcup, with at least one to lose A&E services; in the North East, A&E services at King George’s Hospital, Ilford are already being run down; in the North West , reductions have already been made in A&E at Central Middlesex Hospital ; and in north London , the two options out for “consultation” both mean the closure of A&E at Enfield ’s Chase Farm Hospital.

Meanwhile Kingston Hospital Trust, claiming to be implementing the Darzi report, has outlined plans to hand the operation of its entire elective surgery service to a private sector company.

LHE has called upon London ’s Strategic Health Authority, NHS London, to call Trusts and PCTs to order and impose a moratorium on cuts, closures and major policy decisions while the debate takes place on the Darzi report.

NHS London for its part has allocated a £15m budget for consultation and further “work programmes” on Darzi, setting a timetable for completing the consultation by February 2008. But it has pulled up short of imposing a moratorium, allowing PCTs to press ahead with “urgent service change proposals” which cannot be left until next year.

So far health chiefs in South East London claim to have postponed the consultation process, due to start in September, but have continued - despite their public denials - to meet behind the scenes and prepare to implement their planned cutbacks.

There are no signs that the juggernaut towards closure of Chase Farm’s A&E, which launched in June at a meeting of NHS London, will be slowed or halted for the Darzi debate. Elsewhere campaigners have to wait and see.

So is Darzi and his reports simply a sideshow to facilitate easier cutbacks? Or will he be allowed to use his ministerial post to force through some of the changes he proposes?

The answer from Manchester seems to be that with or without Darzi campaigners will have to remain active and vigilant throughout, using every avenue to defend local, accessible services.

And the unions, which have in general taken such a low-key line on the hospital cuts and closures, need to mobilise now if they are to stand any chance of protecting their member’s jobs and local services.

www.healthemergency.org.uk