The UK has recently been lamenting the decline of long established high street businesses that have gone into administration, particularly in relation to the ensuing impact of job losses, and lost goods or services to customers.
The introduction of a Trust Special Administrator into the NHS in 2012 to manage the deficit at South London Healthcare was an unwelcome precedent likely to result in similar poor outcomes for the stores, its staff, and local area.
The fate of stores such as Jessops and HMV are particularly hard as their staff are part of the community and have largely been unceremoniously dumped out of the jobs, a harm that will impact their families and prospects. This has led to some desperation among Jessops’s now unemployed staff.
Like Jessops, the Trust Special Administrator (TSA) made a recommendation South London Healthcare NHS trust be dissolved.
However, Michael Kershaw (the special administrator) is using the process to restructure all main NHS health services in south east London, including significant reduction of emergency care and maternity services at Lewisham Hospital.
In his final report, he stated:
“The TSA has concluded that these sites cannot be made financially viable in the current service and organisational arrangements. To continue in this form would require the Trust to be sustained indefinitely by cash support from the Department of Health.
“In view of this, recommendation 5 proposes a necessary reorganisation of services across south east London.”
Health secretary Jeremy Hunt and the special administrator were due to meet with local MPs to enable the former to make a decision on the report recommendations by February 1st.
What is clear from the campaign against the loss of these services from Lewisham Hospital is the primary concern is about the loss of vital health services. However, there is another layer of meaning and benefit for communities about loss of services where they had positive and memorable experiences.
It is very nice to be able to go a hospital to have your baby, which is the same place you had your previous children, and where you mother gave birth to you.
As well as changes to roles, movement to new jobs, or possible redundancies for NHS staff, and loss of services, there will be a wider impact on the community, of hospital closure or loss of key services.
Most hospitals draw a large number of volunteers from the local community, people who want to give something back and help others. Additionally, many NHS trusts have developed their own charities to provide vital funds to add enhancements to patient experience, and increasingly, important hospital equipment.
Hospital volunteers and charity fundraisers gain key benefits from pursuing their activities. Many are retired, some with disabilities or long term health conditions; some are socially isolated; and some are unemployed young people seeking experience to help them into work or further training.
They act as welcomers to greet and guide anxious arriving patients; they are meal companions feeding vulnerable patients; and they are befrienders visiting isolated patients. They also perform a range of administration, and semi-skilled roles in the NHS offices, that have been progressively stripped of paid staff since 2010. For no financial reward, they are saving the NHS many millions that it would cost to pay them.
Loss of hospital departments and hospitals has a major impact on volunteers who are often in their roles for much longer than staff, and hold a lot of organisational memory.
Networks, relationships and communities, frequently described as social capital, grow up around hospitals, and are therefore put at risk at risk with closures, much in the same way as post office and high street store closures.
David Cameron is introducing a change from April 2013 to systematically ask all NHS patients whether they would recommend a service they have used to friends and family, if they need the same care or treatment. But what do these recommendations mean when an administrator is introduced to manage an NHS trust with problems and makes drastic recommendations against the interests of patients and communities?
Securing economic efficiency and sustainability in the NHS is essential, but this needs to be clearly aligned to the needs of the community. PwC, the administrator for Jessops, and Michael Kershaw, the special administrator for South London Healthcare NHS Trust, are proceeding with a business focus, not considering the broader impact or fall out of their courses of action on communities and people.