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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Who will win in Copeland? The Labour heartland hangs in the balance

The knife-edge by-election could end 82 years of Labour rule on the West Cumbrian coast.

Fine, relentless drizzle shrouds Whitehaven, a harbour town exposed on the outer edge of Copeland, West Cumbria. It is the most populous part of the coastal north-western constituency, which takes in everything from this old fishing port to Sellafield nuclear power station to England’s tallest mountain Scafell Pike. Sprawling and remote, it protrudes from the heart of the Lake District out into the Irish Sea.

Billy, a 72-year-old Whitehaven resident, is out for a morning walk along the marina with two friends, his woolly-hatted head held high against the whipping rain. He worked down the pit at the Haig Colliery for 27 years until it closed, and now works at Sellafield on contract, where he’s been since the age of 42.

“Whatever happens, a change has got to happen,” he says, hands stuffed into the pockets of his thick fleece. “If I do vote, the Bootle lass talks well for the Tories. They’re the favourites. If me mam heard me saying this now, she’d have battered us!” he laughs. “We were a big Labour family. But their vote has gone. Jeremy Corbyn – what is he?”

The Conservatives have their sights on traditional Labour voters like Billy, who have been returning Labour MPs for 82 years, to make the first government gain in a by-election since 1982.

Copeland has become increasingly marginal, held with just 2,564 votes by former frontbencher Jamie Reed, who resigned from Parliament last December to take a job at the nuclear plant. He triggered a by-election now regarded by all sides as too close to call. “I wouldn’t put a penny on it,” is how one local activist sums up the mood.

There are 10,000 people employed at the Sellafield site, and 21,000 jobs are promised for nearby Moorside – a project to build Europe’s largest nuclear power station now thrown into doubt, with Japanese company Toshiba likely to pull out.

Tories believe Jeremy Corbyn’s stance on nuclear power (he limply conceded it could be part of the “energy mix” recently, but his long prevarication betrayed his scepticism) and opposition to Trident, which is hosted in the neighbouring constituency of Barrow-in-Furness, could put off local employees who usually stick to Labour.

But it’s not that simple. The constituency may rely on nuclear for jobs, but I found a notable lack of affection for the industry. While most see the employment benefits, there is less enthusiasm for Sellafield being part of their home’s identity – particularly in Whitehaven, which houses the majority of employees in the constituency. Also, unions representing Sellafield workers have been in a dispute for months with ministers over pension cut plans.

“I worked at Sellafield for 30 years, and I’m against it,” growls Fred, Billy’s friend, a retiree of the same age who also used to work at the colliery. “Can you see nuclear power as safer than coal?” he asks, wild wiry eyebrows raised. “I’m a pit man; there was just nowhere else to work [when the colliery closed]. The pension scheme used to be second-to-none, now they’re trying to cut it, changing the terms.”

Derek Bone, a 51-year-old who has been a storeman at the plant for 15 years, is equally unconvinced. I meet him walking his dog along the seafront. “This county, Cumbria, Copeland, has always been a nuclear area – whether we like it or don’t,” he says, over the impatient barks of his Yorkshire terrier Milo. “But people say it’s only to do with Copeland. It ain’t. It employs a lot of people in the UK, outside the county – then they’re spending the money back where they’re from, not here.”

Such views might be just enough of a buffer against the damage caused by Corbyn’s nuclear reluctance. But the problem for Labour is that neither Fred nor Derek are particularly bothered about the result. While awareness of the by-election is high, many tell me that they won’t be voting this time. “Jeremy Corbyn says he’s against it [nuclear], now he’s not, and he could change his mind – I don’t believe any of them,” says Malcolm Campbell, a 55-year-old lorry driver who is part of the nuclear supply chain.

Also worrying for Labour is the deprivation in Copeland. Everyone I speak to complains about poor infrastructure, shoddy roads, derelict buildings, and lack of investment. This could punish the party that has been in power locally for so long.

The Tory candidate Trudy Harrison, who grew up in the coastal village of Seascale and now lives in Bootle, at the southern end of the constituency, claims local Labour rule has been ineffective. “We’re isolated, we’re remote, we’ve been forgotten and ignored by Labour for far too long,” she says.

I meet her in the town of Millom, at the southern tip of the constituency – the opposite end to Whitehaven. It centres on a small market square dominated by a smart 19th-century town hall with a mint-green domed clock tower. This is good Tory door-knocking territory; Millom has a Conservative-led town council.

While Harrison’s Labour opponents are relying on their legacy vote to turn out, Harrison is hoping that the same people think it’s time for a change, and can be combined with the existing Tory vote in places like Millom. “After 82 years of Labour rule, this is a huge ask,” she admits.

Another challenge for Harrison is the threat to services at Whitehaven’s West Cumberland Hospital. It has been proposed for a downgrade, which would mean those seeking urgent care – including children, stroke sufferers, and those in need of major trauma treatment and maternity care beyond midwifery – would have to travel the 40-mile journey to Carlisle on the notoriously bad A595 road.

Labour is blaming this on Conservative cuts to health spending, and indeed, Theresa May dodged calls to rescue the hospital in her campaign visit last week. “The Lady’s Not For Talking,” was one local paper front page. It also helps that Labour’s candidate, Gillian Troughton, is a St John Ambulance driver, who has driven the dangerous journey on a blue light.

“Seeing the health service having services taken away in the name of centralisation and saving money is just heart-breaking,” she tells me. “People are genuinely frightened . . . If we have a Tory MP, that essentially gives them the green light to say ‘this is OK’.”

But Harrison believes she would be best-placed to reverse the hospital downgrade. “[I] will have the ear of government,” she insists. “I stand the very best chance of making sure we save those essential services.”

Voters are concerned about the hospital, but divided on the idea that a Tory MP would have more power to save it.

“What the Conservatives are doing with the hospitals is disgusting,” a 44-year-old carer from Copeland’s second most-populated town of Egremont tells me. Her partner, Shaun Grant, who works as a labourer, agrees. “You have to travel to Carlisle – it could take one hour 40 minutes; the road is unpredictable.” They will both vote Labour.

Ken, a Conservative voter, counters: “People will lose their lives over it – we need someone in the circle, who can influence the government, to change it. I think the government would reward us for voting Tory.”

Fog engulfs the jagged coastline and rolling hills of Copeland as the sun begins to set on Sunday evening. But for most voters and campaigners here, the dense grey horizon is far clearer than what the result will be after going to the polls on Thursday.

Anoosh Chakelian is senior writer at the New Statesman.