Lewisham: the most irrational, irresponsible hospital to cut

To cut this well-performing hospital would be to reward failure and punish success.

I was born in Lewisham hospital. My mum was convinced that she’d eaten some dodgy mackerel, but it turned out to be contractions. She was rushed in, and both of us were pretty grateful for the kindness and expertise staff showed in helping a frightened mother deliver a safe birth. So when I heard that Lewisham might be losing most of its maternity and other key services to cuts, I decided to go back and visit.

But walking through the hospital’s glass doors in the bustling heart of South London, I was determined not to be sentimental. Months of covering health news for the Guardian taught me that some closures are inevitable. The left loses credibility by not recognising that. We must be prepared to accept uncomfortable truths. The problem is that this might just be the most irrational, irresponsible hospital to cut:

“Here we are bang in the middle of Lewisham, a real community hospital doing exactly what the government wants,” consultant physician John Miell tells me in the hospital canteen. “We have great health reports from objective sources and our finances are more sound than our neighbours. Now the government are ripping the heart out of this community… If they can close Lewisham, they can close anywhere.”

The facts back him up. Lewisham has ranked in the top forty hospitals in the country for the last four years, and its safeguarding services have just been marked excellent by Ofsted (pdf). Lewisham will not be closing services because of failure; it will be closing to protect other hospitals that are too expensive to close because of bad management and botched PFI contracts. As one doctor put it: “We are victims of our success”.

Matthew Kershaw, the man leading the review, makes no secret of this. He has recommended that Lewisham shut all acute services – children, intensive care and most of maternity – simply so that they don’t compete with others in the South London NHS Trust. It’s the worst example of top-down state control rewarding failure. Weren’t the government’s NHS reforms supposed to be about introducing competition to do exactly the opposite?

If the health secretary Jeremy Hunt agrees to these recommendations on 1 February (or before if rumours are believed that he wants to scupper the demonstration this Saturday), good performance will no longer guarantee any sort of protection against closure. As Lucy Mangan says, every hospital in the country will be at risk.

Doctors are also terrified that the consequences of shutting services in a poor, densely populated inner city area with a booming population and a high birth rate have not been thought through. Campaigners say that the changes will leave the local population of 750,000 with just one A&E department.

“Hospitals to the east and west of Lewisham are already full and have been passing their maternity patients to Lewisham,” says Louise Irvine, a local GP who is leading the Save Lewisham Hospital campaign, “The system is already not coping. People are going to die. That’s what we want Hunt to know. He has been duly warned.”

Doctors told me that the local Queen Elizabeth hospital was already transferring children out as far as Margate to cope with over demand. Mums trying to book Kings hospital for births are already being told there is no space. One GP talked about an appendix rupturing in A&E because they couldn’t be seen in time. These stories came from different local hospitals, but everyone felt their position was too precarious to go on the record.

Distance is another problem. Workers for the London Ambulance Service have informally raised concerns about the closure of Lewisham’s A&E department because they know that minutes determine lifetimes. Jos Bell is one local resident who became active in campaigning to save the hospital because of an experience she had a few years ago when she was taken ill and her pulse stopped:

“I wouldn’t have got to Woolwich (the nearest alternative hospital) in time… I would have died in the cab. People will be dropping on route. They are pioneering new treatments at Lewisham. They have saved my life more than once.”

Distance is a bigger problem in poorer areas where car ownership is relatively low. If Lewisham closes its emergency service, some people in Sydenham and Crystal Palace will have to travel for over an hour to get to recommended alternatives.

“For maternity users it’s going to be the most dangerous,” says Jessica Ormerod, a local mother and head of Lewisham’s maternity committee that represents mums in the borough, “They are already vulnerable. Some asylum seekers don’t have the bus fare to get there – at least they can walk to Lewisham.”

Doctors also raised problems of integration – supposedly another key rationale for the health reforms. Right now if a birth goes wrong unexpectedly, mum can be moved to an emergency service across the hall. But under the new proposals, there would be no facilities to do that. If a baby came out with its chord around its neck, patients would have to be transferred by ambulance across town with all the extra risk that brings. I shudder to think of my mum in this position. That could have been me or my little brother.

“We know that most safeguarding failures occur because of a break down between services as people fall through the gap,” says chair of Lewisham’s clinical commissioning group Helen Tattersfield, who maintains the same problem applies to vulnerable groups like self harmers who need social as well as medical support. “If this goes ahead I’ll have patients in five different hospitals and I won’t know they’ll be in the system. It’s a recipe for confusion.”

Kershaw insists that despite extensive consultation, no “viable alternative solutions or proposals been put forward" to solve the challenges faced by the South London Hospital Trust.

If this move made economic sense, perhaps he would have a point. But the Guardian has reported that Kershaw’s proposals would cost £195m to implement, and only deliver £19.5m savings a year. At a time when Lewisham has just invested millions in services that are doing well, this seems wasteful. If you have to close a hospital, why close the one that is doing best?

For many, this is a political decision. Lewisham is a poor area and as one doctor put it, “There is very little to lose when everyone votes Labour here anyway”. The alternative is to close hospitals in Conservative-held areas like Kent, and MPs like Iain Duncan Smith, Chris Grayling and Julian Lewis have already proven that even Tories can’t justify closures in their own backyard. Some call it “fiscal nimbyism”. Patients and doctors call it understanding the consequences when you’re close to them. Me and my mum can testify to that. 

Editor's note: This piece was edited on 22 January 2013. A reference to St Thomas's hospital had been included in error; this was removed.

A porter pushes resuscitation equipment down a corridor at Lewisham Hospital. Photograph: Getty Images

Rowenna Davis is Labour PPC for Southampton Itchen and a councillor for Peckham

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The wildfire victims of forestry neglect - and the trees that saved them

Events in Portugal show how present mismanagement of the natural world reaches far beyond climate change, while also leaving communities more vulnerable to its effects.

When guesthouse owner Liedewij Schieving first heard about the wildfire in nearby Pedrogado Grande, she wasn’t overly concerned. “We always have fires here,” she explains at her home deep in the central Portugese forest.

It was only later that night, eating outside with her 11 guests, that the fear set in: “The wind was starting to smell and the sunset looked weird and dark.” By early the next morning the vast wall of flames had breached their remote valley. “I’ve never been in a war,” Liedewij says, still shaken, “but it was how I imagine war to sound.”

Soaring to temperatures of over 800 centigrade - high enough to melt windscreens and sink tyres into tarmac - the inferno eventually burned over 30,000 hectares of forest. By the time it was quelled, 64 adults and children had lost their lives, some dying trapped in their cars as they tried to escape down an unsafe road. “The biggest tragedy of human life we have known in years,” is how the country’s Prime Minister responded to the news on 18 June.

Two months later, the Pedrogado fire has proved the precusor to another summer of extreme weather events. Across southern and central Europe recent weeks have seen high winds and low humidity whip up wildfires everywhere from Spain to Serbia. At time of writing, 2,000 people in Portugal are trapped in the town of Mação as flames and smoke block their exit. In France, fires recently forced over 20,000 people from their homes and campervans.

Climate change is an unmistakable culprit. A Carbon Brief analysis of 140 studies from around the world found that 63 per cent of extreme weather events are linked to human-caused warming - making them either more likely or more severe.

Yet as countries assess the damage, evidence of humanity’s wider mismanagement of nature is also becoming harder to ignore. In Portugal, the excessive planting of eucalytpus trees is taking some of the blame for recent events. The species is the timber of choice for the country’s powerful paper industry, covering both industry-owned plantations and hundreds of tiny private smallholdings who sell it on. But it also happens to be highly flammable: think Grenfell cladding but spread over nearly a million hectares of land.

Liedewij’s story is evidence of this. Where dense eucalyptus forest once hid her home in dappled shade, the hillside is now charred and bare. “It was terrible,” she says of the moment she opened the gates for the farm animals before fleeing the valley, “we thought we were leaving them behind to grill”. Except that, as in all good disaster films, Liedewij’s goats didn’t burn - and nor did her picturesque house. Instead, fire-retardant willow trees by a nearby stream held the flames naturally at bay. On returning the next morning, she even found the hens laying eggs.

Liedewij Schieving outside her B&B at Quinta da Fonte - the bare hills behind the house show just how close the fire came.

Seen from above, her remote farmstead is now a tiny island of green amid a sea of black. She still panics at the smell from the woodfired heating, but support has poured in from friends both in Portugal and her native Holland, and she soon plans to fully re-open Quinta da Fonte B&B. Many guesthouses in nearby villages have already got back up and running.

Others among her neighbours, however, are not so lucky. Over 10,000 separate fires have destroyed 141,000 hectares of land in Portugal this year alone, with the annual cost of wildfire losses estimated to reach around €200m. A situation that risks further perpetuating the cycle of poverty and neglect that also played their part in the tragedy.

According to Domingos Patacho from the environmental NGO Quercus, the forest has become more hazardous as many of central Portugal's thousands of smallscale landholders leave their land untended to seek better wages elsewhere. Meanwhile, those who remain are often financially dependent on the income from the eucalyptus. They could choose to plant less flammable and water-hungry species, such as native corks or oaks, Patacho explains, but these can take twice as long to mature and provide a return.

The result is rising tension between the Portugese paper industry and the central government. After the June fire, the parliament pledged to push ahead with plans to limit the monoculture plantations. But the country’s Association of the Paper industry has previously warned that any ban on new plantations could hurt exports and jobs.

The reality is that both sides of the eucalyptus spread - both industry-owned and private - need improved regulation. But in a country only recently released from EU imposed austerity measures, debates over how enforcement could be financed are particularly tense. Not least since many areas do not even have an up to date land register, Patacho expplains.

At ESAC, an agrarian research base in central Portugal, professor Antonio Ferreira believes the time is now ripe for discussion between politicians, citizens and researchers about the future of forest land-use as a whole. The country needs to encourage people “to re-introduce native species, which will diversify the landscape and economic activity in those areas,” he says.

And the impulse is far from limited to Portugal. “We need to look at all the social aspects to get the full picture as well as the scientific side of forest management,” says WWF’s Jabier Ruiz of Europe’s wider wildfire problems. One route out of the woods may be greater EU policy support for those living in marginalised, rural areas, he adds.

What is clear is that as the continent warms, the need to improve the balance between social, environmental and commercial interests becomes ever more crucial. And while politicians debate, work at Liedewij’s home is already underway. Over the next few weeks, a group of her eco-minded friends, builders and topographers will help her re-build and re-landscape her farm. From digging terraces to stop landslides, to preventing the eucalyptus from re-emerging too close to the roads, their aim is to regrow a forest that works for all: a slow-burn project perhaps, but a bright one.

India Bourke is an environment writer and editorial assistant at the New Statesman.