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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BHS is Theresa May’s big chance to reform capitalism – she’d better take it

Almost everyone is disgusted by the tale of BHS. 

Back in 2013, Theresa May gave a speech that might yet prove significant. In it, she declared: “Believing in free markets doesn’t mean we believe that anything goes.”

Capitalism wasn’t perfect, she continued: 

“Where it’s manifestly failing, where it’s losing public support, where it’s not helping to provide opportunity for all, we have to reform it.”

Three years on and just days into her premiership, May has the chance to be a reformist, thanks to one hell of an example of failing capitalism – BHS. 

The report from the Work and Pensions select committee was damning. Philip Green, the business tycoon, bought BHS and took more out than he put in. In a difficult environment, and without new investment, it began to bleed money. Green’s prize became a liability, and by 2014 he was desperate to get rid of it. He found a willing buyer, Paul Sutton, but the buyer had previously been convicted of fraud. So he sold it to Sutton’s former driver instead, for a quid. Yes, you read that right. He sold it to a crook’s driver for a quid.

This might all sound like a ludicrous but entertaining deal, if it wasn’t for the thousands of hapless BHS workers involved. One year later, the business collapsed, along with their job prospects. Not only that, but Green’s lack of attention to the pension fund meant their dreams of a comfortable retirement were now in jeopardy. 

The report called BHS “the unacceptable face of capitalism”. It concluded: 

"The truth is that a large proportion of those who have got rich or richer off the back of BHS are to blame. Sir Philip Green, Dominic Chappell and their respective directors, advisers and hangers-on are all culpable. 

“The tragedy is that those who have lost out are the ordinary employees and pensioners.”

May appears to agree. Her spokeswoman told journalists the PM would “look carefully” at policies to tackle “corporate irresponsibility”. 

She should take the opportunity.

Attempts to reshape capitalism are almost always blunted in practice. Corporations can make threats of their own. Think of Google’s sweetheart tax deals, banks’ excessive pay. Each time politicians tried to clamp down, there were threats of moving overseas. If the economy weakens in response to Brexit, the power to call the shots should tip more towards these companies. 

But this time, there will be few defenders of the BHS approach.

Firstly, the report's revelations about corporate governance damage many well-known brands, which are tarnished by association. Financial services firms will be just as keen as the public to avoid another BHS. Simon Walker, director general of the Institute of Directors, said that the circumstances of the collapse of BHS were “a blight on the reputation of British business”.

Secondly, the pensions issue will not go away. Neglected by Green until it was too late, the £571m hole in the BHS pension finances is extreme. But Tom McPhail from pensions firm Hargreaves Lansdown has warned there are thousands of other defined benefit schemes struggling with deficits. In the light of BHS, May has an opportunity to take an otherwise dusty issue – protections for workplace pensions - and place it top of the agenda. 

Thirdly, the BHS scandal is wreathed in the kind of opaque company structures loathed by voters on the left and right alike. The report found the Green family used private, offshore companies to direct the flow of money away from BHS, which made it in turn hard to investigate. The report stated: “These arrangements were designed to reduce tax bills. They have also had the effect of reducing levels of corporate transparency.”

BHS may have failed as a company, but its demise has succeeded in uniting the left and right. Trade unionists want more protection for workers; City boys are worried about their reputation; patriots mourn the death of a proud British company. May has a mandate to clean up capitalism - she should seize it.