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

Garry Knight via Creative Commons
Show Hide image

Why Barack Obama was right to release Chelsea Manning

A Presidential act of mercy is good for Manning, but also for the US.

In early 2010, a young US military intelligence analyst on an army base near Baghdad slipped a Lady Gaga CD into a computer and sang along to the music. In fact, the soldier's apparently upbeat mood hid two facts. 

First, the soldier later known as Chelsea Manning was completely alienated from army culture, and the callous way she believed it treated civilians in Iraq. And second, she was quietly erasing the music on her CDs and replacing it with files holding explosive military data, which she would release to the world via Wikileaks. 

To some, Manning is a free speech hero. To others, she is a traitor. President Barack Obama’s decision to commute her 35-year sentence before leaving office has been blasted as “outrageous” by leading Republican Paul Ryan. Other Republican critics argue Obama is rewarding an act that endangered the lives of soldiers and intelligence operatives while giving ammunition to Russia. 

They have a point. Liberals banging the drum against Russia’s leak offensive during the US election cannot simultaneously argue leaks are inherently good. 

But even if you think Manning was deeply misguided in her use of Lady Gaga CDs, there are strong reasons why we should celebrate her release. 

1. She was not judged on the public interest

Manning was motivated by what she believed to be human rights abuses in Iraq, but her public interest defence has never been tested. 

The leaks were undoubtedly of public interest. As Manning said in the podcast she recorded with Amnesty International: “When we made mistakes, planning operations, innocent people died.” 

Thanks to Manning’s leak, we also know about the Vatican hiding sex abuse scandals in Ireland, plus the UK promising to protect US interests during the Chilcot Inquiry. 

In countries such as Germany, Canada and Denmark, whistle blowers in sensitive areas can use a public interest defence. In the US, however, such a defence does not exist – meaning it is impossible for Manning to legally argue her actions were in the public good. 

2. She was deemed worse than rapists and murderers

Her sentence was out of proportion to her crime. Compare her 35-year sentence to that received by William Millay, a young police officer, also in 2013. Caught in the act of trying to sell classified documents to someone he believed was a Russian intelligence officer, he was given 16 years

According to Amnesty International: “Manning’s sentence was much longer than other members of the military convicted of charges such as murder, rape and war crimes, as well as any others who were convicted of leaking classified materials to the public.”

3. Her time in jail was particularly miserable 

Manning’s conditions in jail do nothing to dispel the idea she has been treated extraordinarily harshly. When initially placed in solitary confinement, she needed permission to do anything in her cell, even walking around to exercise. 

When she requested treatment for her gender dysphoria, the military prison’s initial response was a blanket refusal – despite the fact many civilian prisons accept the idea that trans inmates are entitled to hormones. Manning has attempted suicide several times. She finally received permission to receive gender transition surgery in 2016 after a hunger strike

4. Julian Assange can stop acting like a martyr

Internationally, Manning’s continued incarceration was likely to do more harm than good. She has said she is sorry “for hurting the US”. Her worldwide following has turned her into an icon of US hypocrisy on free speech.

Then there's the fact Wikileaks said its founder Julian Assange would agree to be extradited to the US if Manning was released. Now that Manning is months away from freedom, his excuses for staying in the Equadorian London Embassy to avoid Swedish rape allegations are somewhat feebler.  

As for the President - under whose watch Manning was prosecuted - he may be leaving his office with his legacy in peril, but with one stroke of his pen, he has changed a life. Manning, now 29, could have expected to leave prison in her late 50s. Instead, she'll be free before her 30th birthday. And perhaps the Equadorian ambassador will finally get his room back. 

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.