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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Hannan Fodder: This week, Daniel Hannan gets his excuses in early

I didn't do it. 

Since Daniel Hannan, a formerly obscure MEP, has emerged as the anointed intellectual of the Brexit elite, The Staggers is charting his ascendancy...

When I started this column, there were some nay-sayers talking Britain down by doubting that I was seriously going to write about Daniel Hannan every week. Surely no one could be that obsessed with the activities of one obscure MEP? And surely no politician could say enough ludicrous things to be worthy of such an obsession?

They were wrong, on both counts. Daniel and I are as one on this: Leave and Remain, working hand in glove to deliver on our shared national mission. There’s a lesson there for my fellow Remoaners, I’m sure.

Anyway. It’s week three, and just as I was worrying what I might write this week, Dan has ridden to the rescue by writing not one but two columns making the same argument – using, indeed, many of the exact same phrases (“not a club, but a protection racket”). Like all the most effective political campaigns, Dan has a message of the week.

First up, on Monday, there was this headline, in the conservative American journal, the Washington Examiner:

“Why Brexit should work out for everyone”

And yesterday, there was his column on Conservative Home:

“We will get a good deal – because rational self-interest will overcome the Eurocrats’ fury”

The message of the two columns is straightforward: cooler heads will prevail. Britain wants an amicable separation. The EU needs Britain’s military strength and budget contributions, and both sides want to keep the single market intact.

The Con Home piece makes the further argument that it’s only the Eurocrats who want to be hardline about this. National governments – who have to answer to actual electorates – will be more willing to negotiate.

And so, for all the bluster now, Theresa May and Donald Tusk will be skipping through a meadow, arm in arm, before the year is out.

Before we go any further, I have a confession: I found myself nodding along with some of this. Yes, of course it’s in nobody’s interests to create unnecessary enmity between Britain and the continent. Of course no one will want to crash the economy. Of course.

I’ve been told by friends on the centre-right that Hannan has a compelling, faintly hypnotic quality when he speaks and, in retrospect, this brief moment of finding myself half-agreeing with him scares the living shit out of me. So from this point on, I’d like everyone to keep an eye on me in case I start going weird, and to give me a sharp whack round the back of the head if you ever catch me starting a tweet with the word, “Friends-”.

Anyway. Shortly after reading things, reality began to dawn for me in a way it apparently hasn’t for Daniel Hannan, and I began cataloguing the ways in which his argument is stupid.

Problem number one: Remarkably for a man who’s been in the European Parliament for nearly two decades, he’s misunderstood the EU. He notes that “deeper integration can be more like a religious dogma than a political creed”, but entirely misses the reason for this. For many Europeans, especially those from countries which didn’t have as much fun in the Second World War as Britain did, the EU, for all its myriad flaws, is something to which they feel an emotional attachment: not their country, but not something entirely separate from it either.

Consequently, it’s neither a club, nor a “protection racket”: it’s more akin to a family. A rational and sensible Brexit will be difficult for the exact same reasons that so few divorcing couples rationally agree not to bother wasting money on lawyers: because the very act of leaving feels like a betrayal.

Or, to put it more concisely, courtesy of Buzzfeed’s Marie Le Conte:

Problem number two: even if everyone was to negotiate purely in terms of rational interest, our interests are not the same. The over-riding goal of German policy for decades has been to hold the EU together, even if that creates other problems. (Exhibit A: Greece.) So there’s at least a chance that the German leadership will genuinely see deterring more departures as more important than mutual prosperity or a good relationship with Britain.

And France, whose presidential candidates are lining up to give Britain a kicking, is mysteriously not mentioned anywhere in either of Daniel’s columns, presumably because doing so would undermine his argument.

So – the list of priorities Hannan describes may look rational from a British perspective. Unfortunately, though, the people on the other side of the negotiating table won’t have a British perspective.

Problem number three is this line from the Con Home piece:

“Might it truly be more interested in deterring states from leaving than in promoting the welfare of its peoples? If so, there surely can be no further doubt that we were right to opt out.”

If there any rhetorical technique more skin-crawlingly horrible, than, “Your response to my behaviour justifies my behaviour”?

I could go on, about how there’s no reason to think that Daniel’s relatively gentle vision of Brexit is shared by Nigel Farage, UKIP, or a significant number of those who voted Leave. Or about the polls which show that, far from the EU’s response to the referendum pushing more European nations towards the door, support for the union has actually spiked since the referendum – that Britain has become not a beacon of hope but a cautionary tale.

But I’m running out of words, and there’ll be other chances to explore such things. So instead I’m going to end on this:

Hannan’s argument – that only an irrational Europe would not deliver a good Brexit – is remarkably, parodically self-serving. It allows him to believe that, if Brexit goes horribly wrong, well, it must all be the fault of those inflexible Eurocrats, mustn’t it? It can’t possibly be because Brexit was a bad idea in the first place, or because liberal Leavers used nasty, populist ones to achieve their goals.

Read today, there are elements of Hannan’s columns that are compelling, even persuasive. From the perspective of 2020, I fear, they might simply read like one long explanation of why nothing that has happened since will have been his fault.

Jonn Elledge is the editor of the New Statesman's sister site CityMetric. He is on Twitter, far too much, as @JonnElledge.