Justice for Lewisham Week

After nine months of a very vigorous fight to save Lewisham Hospital in South East London, the Save Lewisham Hospital Campaign (SLHC) reached a significant stage in its work with the “Justice for Lewisham Week” of June 29 to July 5. It comprised the People’s Commission and the Judicial Review, the legal challenge against Health Secretary Jeremy Hunt made by Lewisham Council and the SLHC.

The background to the Justice for Lewisham Week is Hunt’s decision on January 31 to endorse the South East London Trust Special Administrator (TSA) Matthew Kershaw’s proposal to downgrade Lewisham Hospital as part of his reorganisation of hospital provision in South East London Health Care Trust (SLHT) which is bankrupt largely through PFI debts. Kershaw tried to offload the financial problems of the SLHT onto Lewisham Hospital even though it is a solvent and successful hospital and not part of the SLHT.

Lewisham People’s Commission

The People’s Commission took place at the Catford Broadway Theatre on June 29. The form of the People’s Commission was that of a genuine commission of enquiry in which expert witnesses, leading clinicians, GPs, nurses, patients and community members gave evidence about the government proposals for Lewisham Hospital in the context of the anti-social direction for the NHS as a whole. Michael Mansfield QC chaired the Commission and a team of barristers conducted the examinations. The Commission panel also consisted of Baroness Warnock and award-winning poet author and journalist Blake Morrison.

It is significant that a working group within the SLHC, one of a number it has set up to advance its work, spent many months of intense planning and organisation to ensure that the Commission was successful and fulfilled its aim. A Conference Pack was given to the several hundred people who attended containing London Health Emergency’s critical response to the TSA’s draft report “Saving the cancer, sacrificing the patient”, together with Professor Colin Leys’ “The Plot Against the NHS” and the SLHC’s response to the TSA’s draft report.

Lord David Owen Lord David Owen gave an introductory speech in defence of the NHS and the Mayor of Lewisham Sir Steve Bullock spoke of the court case Lewisham Council is conducting against the government’s decision to downgrade Lewisham Hospital. There were also contributions by Colin Leys and Allyson Pollock.

The evidence presented represented a thorough-going exposure of the government’s wrecking of the NHS in the service of private interests. The speakers gave powerful and irrefutable factual evidence against TSA plan; its proposals were revealed as being nonsense and a total sham driven by financial considerations not health care needs. What also emerged was the incoherence even of their financial considerations. The huge cost of implementing the proposals would mean it would take at least 10 years for any financial benefits to result from the closure of Lewisham hospital. Sir Bruce Keogh’s claim the proposals would “save 100 lives a year” was exposed as being the fictitious nonsense it was, as also was the truly risible claim that travel times to other hospitals would only be increased by one minute. The effects of PFI were also revealed as being devastating, with as much as 30-60 years being required to pay off the debts. The witnesses who spoke at the Commission, plus many other witnesses whose evidence had been previously recorded, incisively and often movingly spoke of the devastating effect the government’s proposals would have, not just for the people of Lewisham but throughout South East London.

The day was divided into six sessions, each dealing with different aspect of healthcare needs. As well as live witnesses, video testimonies were presented. In the first session, “The NHS – the broader context”, the witnesses were Sally and Deion Stephenson, a mother and her son who has very serious long-term medical condition and who has been treated at Lewisham Hospital for many years. They both informed the Commission that having to go to another hospital would break up this care and trust, quite apart from the huge problems of extra travel time. At the end of the questioning Michael Mansfield asked Deion if he had a message for Geoffrey Hunt, and his response was, “Get real!” This could be said to have set the theme for the day – the reality of what witnesses put forward in stark opposition to the tissue of lies, misinformation, deception and disregard for the realities of healthcare needs for the people of South East London from the government.

Session two was on “The Bigger Picture”, with video testimonies and speakers including the Chief Executive of Lewisham Healthcare Trust, Tim Higginson.

Blake Morrison, Michael Mansfield
and Baroness WarnockIn the third session, “GPs and the Community”, Dr Helen Tattersfield, Chair of Lewisham Clinical Commissioning Group (CCG), gave her remarkable testimony. She explained how in six months the CCG had striven to improve health care in Lewisham by working closely with other healthcare groups. She emphasised, to great applause from the audience, “It shows what you can do when you work together.” The importance of collaboration and building up networks between different health sections was one of the most important aspects of healthcare that the Commission brought out, which would be destroyed if the TSA proposals were adopted. When asked what the most serious ramifications of these changes were, she replied starkly, “The breakdown of these services.” She further explained that if Lewisham hospital closed the result would be a service fragmented between four other hospitals, and patients would suffer.

When asked about the TSA’s “consultation”, Helen Tattersfield told the Commission that they were presented with documents as a fait accompli. “This is what has to happen,” the CCG was told. They were not allowed to contest details and, she said, “reality was ignored”. When asked to comment on the Secretary of State’s claims that the proposals had “clinical support” she replied (to applause), “certainly not Lewisham’s support”. Michael Mansfield then brought up the Secretary of State’s claims that the proposals have clinical support, pointing out that 160 GPs had a signed a petition against the proposals, and asked Helen Tattersfield if there was any truth in the Secretary of State’s claim. She said that in all the meetings she attended all the points she raised were ignored with no one talking about the integration of services only the need for “specialists”.

In the fourth session, dealing with A&E, ambulances, and the impact on the elderly, Chidi Ejimofo, a LH A&E consultant, pointed out that Jeremy Hunt’s proposal to downgrade Lewisham’s A&E demonstrated the Secretary of State’s lack of understanding of what constitutes an A&E. Reducing the department to a “healthcare centre” without clinical and surgical backup would mean it would no longer by definition be an A&E.

Session five dealt with “Maternity Services”, with evidence given from consultants, as well as mothers who have formed a significant contingent in the campaign.

In the final session, “Effect on the seriously ill in the community, Children’s services”, Dr Tony O’Sullivan, Consultant paediatrician, Director of Children’s services for Lewisham Hospital and a leading activist and spokesperson for the SLHC, explained how he had been working in Lewisham for 20 years building networks for children – often very vulnerable, often in advance of government policy – across health agencies to build a supportive environment. He said that care for the elderly and mental health would be destroyed if Lewisham hospital closed with services going out to three or four different boroughs. Dr O’Sullivan further said that the proposals would lead to worse care and refuted the claims made by Sir Bruce Keogh that under Kershaw’s plans children’s services would be “well provided for”. He said that no risk assessment had been made, and the consultation from Matthew Kershaw was in reality virtually zero. The TSA report had totally ignored children except as numerical statistics and even their figures were inaccurate! Dr O’Sullivan, along with many other witnesses, said that the consultation had been a total sham. In fact, the “blue sky thinking” they had advocated was limited to the size of the TSA consultant’s fees!

Dr Louise IrvineLouise Irvine, GP and chair of the SLHC was the last witness. She said that it was outrageous to suggest that it was easy to access care for Lewisham people without Lewisham Hospital. Like many other witnesses, Dr Irvine said that downgrading and closing Lewisham would severely disrupt the close relationships built up over eight years between local GPs, and social and community care. She pointed out that the consultation period, only 30 days, was far too short and the consultation forms very difficult to complete. Like other witnesses, Louise Irvine said the consultation was all about vague “aspirations and visions” without anything concrete in addressing people’s health care needs. When asked about the SLHC, Louise Irvine said that it had been the most amazing experience, with the first meeting, soon after the news of the downgrade was announced in October 2012, attracting 600 people followed by local demonstrations in November 2012 and January 2013 with 15,000 and 25,000 people respectively. Asked what she thought the SLHC revealed about the people of Lewisham, Louise Irvine replied that “they really value the NHS, are prepared to fight, and don’t take things lying down”. She added that the show of passion and intelligence and level of criticism that had been manifest in the evidence has been amazing. “People here are very determined that whatever happens we’re going to keep on fighting to save our hospital.” In answer to a question put to her by Blake Morrison about the sale of land around Lewisham Hospital, Louise Irvine replied that the proposed sale of land would certainly not be used for healthcare but to pay off the PFI “which has to be constantly fed”. She said that the proposals do not even make sense financially as the cost of the re-organisation would be £160 million so with “savings” amounting to £19 million a year it would take at least 10 years to pay off the cost of the re-organisation.

Michael Mansfield QC In his concluding remarks, Michael Mansfield praised the People’s Commission as being “one of the most disciplined, most focussed, most efficient enquiries generated by public consciousness” through the quality of the witnesses and organisation. He wanted to make people at large aware, far beyond Lewisham, what is going on in all welfare services. He spoke of the Commission as demonstrating the possibility of change. Michael Mansfield ended by saying that what was revealed was the absence of democracy in what the government were doing. Jeremy Hunt was “reserving the right to devolve responsibility”, saying, “It’s nothing to do with me – it’s the market.” Michael Mansfield referred to the “set up to fail system in which the private section is going to profit”. He also pointed out that the present situation was a legacy of previous governments, particularly the setting up of PFIs which, he said, have to be revoked. Michael Mansfield said that, in issuing the panel’s report, he wants to demonstrate that the public are not going to put up with being fed with false information and diktats from the government. He concluded finally by saying that the People’s Commission had been a wonderful experience which few of us will ever forget.

In the opinion of WWIE, the Commission was a significant event not only for the SLHC but also for the fight to save the NHS throughout the country. The picture it uncovered, though specific to South London, nevertheless has resonances throughout England. To achieve their full effect, the results and conclusions of the Commission must become widely disseminated. The event was a powerful demonstration of the self-motion of the movement to safeguard the future of the NHS, and its unity in fighting to achieve its aims. As a People’s Commission, it was a powerful contribution to informing the participants and the people at large. It further contributes to the demand to hold the government to account for its wrecking and privatisation of the NHS, to repeal the Health and Social Care Act, to outlaw the dictate of private interests over the NHS, and to ensure a full binding public enquiry with the aim of restoring to the public Treasury what has been stolen through using the health service to pay the rich.

Save Lewisham Hospital Judicial Review

The Judicial Review Hearing was held from July 2-4 at the Royal Courts of Justice in the Strand, central London.

Day 1 of the hearing was preceded by a big demonstration of 150 people outside the court with banners and placards: “Save Lewisham Hospital” and “Justice for Lewisham”. The banner “A Victory for Lewisham Hospital Is a Victory for Everyone” was very prominent. So many people wanted to attend the hearing that Judge Justice Silber agreed to a bigger courtroom to seat the gallery of 70-80 campaigners and delayed the start until they all were seated. The first day was dominated by legal arguments on ultra vires (challenging Hunt on abuse of his powers in shutting down acute and full maternity services) from the Lewisham Council’s barrister.

In Day 2 of the hearing, the government’s legal team tried to argue that “the Trust”, i.e. the one in financial difficulties, could be any trust (e.g. Lewisham Hospital Trust) in order to give the government legal justification for dragging Lewisham Hospital into sorting out the financial debts of a different Trust. The two legal teams representing the SLHC and Lewisham Council dealt with this deceit very effectively. The rest of the day concerned the government’s failure in its re-organisation proposals to meet the “4 Tests” required for NHS reconfigurations, (local GP commissioning support, clinical evidence to justify service changes, enhanced consultation of public and patients and justification for any impact on patient choice). The failure to meet these four tests was very clearly demonstrated in the People’s Commission. Evidence was clearly put forward such as the failure to consult on children entirely, the failure to consult on the maternity option adopted, the lack of clinical evidence that would stand up to scrutiny, and the reduction in choice, especially for women was a blow for the government case.

A dramatic back-drop to Day 3 was NHS London’s announcement that they intend to close nine A&Es from London’s 29 current A&Es over the next five to six years.

As Tony O’Sullivan writes on the Save Lewisham Hospital Campaign website: “The highlight today was the amazingly weak legal defence of why the Government need not pay regard to the 4 Tests commitment repeatedly given by the PM and Secretary of State specifically on Lewisham: that services would not be diminished or closed unless the 4 Tests were met.” The government QC had to argue that the Secretary of State should not be “fettered” by having to keep his promises.

“As a mere health worker in the audience,” Tony O’Sullivan writes, “I felt we had proven that the TSA and Secretary of State both were acting ultra vires – beyond their legal powers – and that the 4 Tests were certainly not met. And saving the best till last, Government guidance on the 4 Tests was quoted: it defines the need for local GP commissioning support as backing from the lead commissioner/CCG for the majority population affected by the service changes – absolutely clear that this means Lewisham CCG for Lewisham people threatened with loss of Lewisham Hospital. This cuts across TSA Kershaw’s deception where he claimed he could take the majority view of six other CCGs ‘out voting’ Lewisham.

“The ’4 Tests’ was a real challenge to the Government side: the QC was unsure whether he could answer the judge as to whether and when the Secretary of State could or should respect these tests – an embarrassing urgent consultation described as a ‘car crash’. We hope that Judge Justice Silber will see the integrity of these and other arguments from our combined challenges and set aside Hunt’s decision to undermine the excellence of Lewisham Hospital by closing essential services.”

At the end of the hearing there was a feeling of great optimism that the SLHC and Lewisham Hospital had won the case against the government hands down. Tony O’Sullivan summed up this feeling by commenting: “I felt extremely proud of our legal team, our community, our hospital and our campaign.”

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Whose NHS? Our NHS!

The Justice for Lewisham Week was a tremendous achievement for the SLHC and one that is likely to have long-term ramifications beyond Lewisham Hospital itself, even beyond the battle to change the direction of the NHS. The SLHC is an inspiring example of large numbers of local people from all walks of life, ages, nationalities all coming together and uniting around one aim – to save their local hospital. But the ramifications of this go far beyond – not only to the whole future of the NHS but as a sign of the times – that people are not going to put up with the continued onslaught by this and previous governments and will fight to hold them to account.

The power, energy and dedication of people in the SLHC have been consolidated and have brought out their creativity through acts of conscious participation which have contributed to the campaign. The inventiveness and the achievements of the campaign have been notable. The People’s Commission shows that the working people in their millions who must be the decision makers, enacting laws and making the crucial decisions governing their lives, not the handful of the rich and their cronies represented by the likes of Hunt and Cameron.

A Victory for Lewisham Hospital is a Victory for Everyone!