Hospital chiefs plan beds massacre

John Lister, London Health Emergency

A Department of Health press release on 2nd June heralded an important, if belated, change of policy. After 20 years of severe cutbacks in hospital acute beds, extra money is to be provided along with instructions that up to 2,000 additional NHS beds should be opened up as part of the drive to reduce soaring hospital waiting lists. Over 1.3 million are currently stuck in the queue for care: and without additional beds and resources, the Government could be trying to explain away even more increases as hospitals fill up with emergencies.

Health Secretary Frank Dobson explicitly denounced the "theology" of some NHS officials who believe that bed closures are essential to make the system more efficient. Plans for the closure of another 1,100 beds have apparently been blocked by ministers. It sounds like good news for patients. Unfortunately, this welcome shift comes in the midst of massive, unprecedented plans by health authorities all over the country to slash the number of front line beds and close down popular community hospitals.

One of the biggest planned cuts is in Worcestershire, where health chiefs are proposing to cut up to 35% of acute beds across the county over just five years, in order to balance the books and make way for a costly new privately financed hospital in Worcester. Worcestershire's Public Health Director Brian McCloskey admits that the plan would axe 27% of acute beds -- but claims that this is in line with "best practice planning assumptions across the NHS". The operative word is "assumptions": there are no examples anywhere in Britain of hospitals working at this level.

The driving force behind many of these schemes is the Private Finance Initiative (PFI), the Tory plan embraced by New Labour, which hands over the planning of hospitals to management consultants -- who are employed not by the NHS but by consortia of private, profit-seeking firms. PFI schemes routinely seek massive reductions in bed numbers, along with huge increases in "throughput" per bed.

The current English average throughput has levelled off at 54 patients per bed per year. But many PFI schemes plan to increase this to 88. The Worcestershire plan implies up to 104 patients per bed -- double the current average! No PFI-built hospital has yet opened: but it is clear that these plans, which have no medical evidence to support them, hinge on a desperate gamble with people's lives.

Frank Dobson indignantly denies any knowledge of the details of merger plans and rationalisation schemes across the country. He has recently shown that he can intervene to boot out incompetent bosses at the National Blood Authority. It's time he asserted his authority to halt the looming massacre of hospital beds.

There has been growing press speculation on the Government plans for a boost in spending as a 50th birthday present for the NHS. Estimates vary as to how much might be on offer -- perhaps an extra £3.6 billion over three years. If this much were to be available as genuine extra money, over and above inflation -- now running at 4% -- it would certainly fill some of the gaps.

But if the new money is simply to be added to the current baseline NHS budget, services will be further squeezed and a new, bigger round of cuts will be triggered. Already a majority of health authorities and three quarters of all Trusts are embroiled in another round of cash cuts as they struggle to balance their books by April 1999.

Campaigners have been disappointed by the Government's retreat over mental health services. After leading pressure groups and lobbyists were led to believe that an extra £3,500 million might be available, ministers have scaled down the handout to a puny £350m a year -- barely enough to make any difference at all to a pressurised service.

Recent pronouncements by Gordon Brown give further cause for concern. Levels of spending are set to rise by even less than they did under the last government, with Brown's main aim to deliver a massive cash surplus for the Exchequer each year. Health unions have been told the squeeze on public sector pay will continue to eat away at salaries, worsening staff shortages and clobbering low-paid support workers.

Fifty years after the post-war Labour Government braved the financial pressures of the day to launch the NHS, their latterday equivalents seem to lack the vision, courage and commitment to pump in the resources needed to restore it to health.

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